{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:41:26Z","timestamp":1783690886568,"version":"3.55.0"},"reference-count":5,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,11,11]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>A 27-year-old woman with moderate congenital ptosis and a positive Marcus-Gunn jaw winking reflex underwent levator resection surgery to correct the ptosis. Preoperatively, a normal Bell\u2019s reflex was documented. Postoperatively, she developed an inverse Bell\u2019s reflex and increased symptoms of ocular surface exposure. The Bell\u2019s reflex normalised in a week, with resolution of the corneal exposure. Reversal of the Bell\u2019s reflex can be an unforeseen complication following maximal levator resection. The early postoperative care in such cases is crucial, and the cornea must be protected from exposure changes. Accurate documentation of the Bell\u2019s phenomenon preoperatively is vital to recognise this rare event and plan management.<\/jats:p>","DOI":"10.1136\/bcr-2019-232451","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T05:49:18Z","timestamp":1575265758000},"page":"e232451","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Inverse Bell\u2019s phenomenon: a rare complication of levator resection surgery in a case of congenital ptosis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4145-1997","authenticated-orcid":false,"given":"Ashi","family":"Morawala","sequence":"first","affiliation":[{"name":"Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhimanyu","family":"Sharma","sequence":"additional","affiliation":[{"name":"Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind N","family":"Naik","sequence":"additional","affiliation":[{"name":"Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,1]]},"reference":[{"key":"2025082622511531000_12.11.e232451.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-005-0122-4"},{"key":"2025082622511531000_12.11.e232451.2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/112067210901900218","article-title":"Two cases of inverse Bell's phenomenon following levator resection: a contemplation of the mechanism","volume":"19","author":"Na","year":"2009","journal-title":"Eur J Ophthalmol"},{"key":"2025082622511531000_12.11.e232451.3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.2174\/1874364101711010024","article-title":"The relationship of amount of resection and time for recovery of Bell's phenomenon after levator resection in congenital ptosis","volume":"11","author":"Goel","year":"2017","journal-title":"Open Ophthalmol J"},{"key":"2025082622511531000_12.11.e232451.4","first-page":"ND01","article-title":"Inverse Bell's phenomenon: rare ophthalmic finding following ptosis surgery","volume":"9","author":"Shitole","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"2025082622511531000_12.11.e232451.5","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/0002-9394(65)93035-7","article-title":"Inverse Bell's phenomenon as a protective mechanism","volume":"59","author":"Gupta","year":"1965","journal-title":"Am J Ophthalmol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232451","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:51:25Z","timestamp":1756273885000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":5,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,12,1]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bcr-2019-232451"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232451","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}