Abstract：
BACKGROUND: Poor Bell\'s phenomenon is often considered a relative contraindication for ptosis surgery, as it increases the risk of corneal exposure and dry eye symptoms after surgery. However, the Bell\'s phenomenon may vary in different individuals and sleep stages, making it inaccurate to predict the position of the eye during sleep based on awake examination. This study aimed to investigate the role of Bell\'s phenomenon in ptosis surgery and the management of nocturnal lagophthalmos.
METHODS: We conducted a retrospective case series of 23 patients with ptosis and poor Bell\'s phenomenon who underwent different surgical techniques at Xijing Hospital from April 2020 to June 2021. We assessed Bell\'s phenomenon at different stages of sleep and collected data on ptosis degree, surgical approach, lagophthalmos, complications, and outcomes.
RESULTS: Of the total 23 patients originally considered for study, 9 with frontalis muscle advancement technique, 8 with conjoint fascial sheath suspension, 4 with levator resection technique, and 2 with levator aponeurosis plication technique. All patients achieved satisfactory correction of ptosis. One patient had prolonged lagophthalmos and underwent reoperation to lower the eyelid height. Other complications were minor and resolved with conservative treatment.
CONCLUSIONS: We conclude that poor Bell\'s phenomenon is not a relative contraindication for ptosis surgery. Nocturnal lagophthalmos should be monitored after ptosis surgery regardless of the Bell\'s phenomenon results. Tape eyelid closure can be an effective solution to protect the corneal surface during nocturnal lagophthalmos.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
METHODS: We conducted a retrospective case series of 23 patients with ptosis and poor Bell\'s phenomenon who underwent different surgical techniques at Xijing Hospital from April 2020 to June 2021. We assessed Bell\'s phenomenon at different stages of sleep and collected data on ptosis degree, surgical approach, lagophthalmos, complications, and outcomes.
RESULTS: Of the total 23 patients originally considered for study, 9 with frontalis muscle advancement technique, 8 with conjoint fascial sheath suspension, 4 with levator resection technique, and 2 with levator aponeurosis plication technique. All patients achieved satisfactory correction of ptosis. One patient had prolonged lagophthalmos and underwent reoperation to lower the eyelid height. Other complications were minor and resolved with conservative treatment.
CONCLUSIONS: We conclude that poor Bell\'s phenomenon is not a relative contraindication for ptosis surgery. Nocturnal lagophthalmos should be monitored after ptosis surgery regardless of the Bell\'s phenomenon results. Tape eyelid closure can be an effective solution to protect the corneal surface during nocturnal lagophthalmos.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
摘要：
背景：差贝尔现象通常被认为是上睑下垂手术的相对禁忌症，因为它增加了手术后角膜暴露和干眼症状的风险。然而,贝尔现象可能在不同的个体和睡眠阶段有所不同，使得基于清醒检查来预测睡眠期间眼睛的位置不准确。本研究旨在探讨贝尔现象在上睑下垂手术中的作用及夜间隐眼的处理方法。
方法：我们对2020年4月至2021年6月在西京医院接受不同手术技术治疗的23例上睑下垂和Bell's差现象患者进行了回顾性病例系列研究。我们评估了不同睡眠阶段的贝尔现象，并收集了下垂程度的数据，手术方法,眼球，并发症,和结果。
结果：在最初考虑研究的23例患者中，9用额肌推进技术，8带联合筋膜鞘悬吊，4采用提上肌切除术技术，2采用提上肌腱膜折叠技术。所有患者均获得满意的下垂矫正。一名患者眼球下垂延长，并接受了再次手术以降低眼睑高度。其他并发症较小，经保守治疗可缓解。
结论：我们得出的结论是，不良的贝尔现象不是上睑下垂手术的相对禁忌症。无论Bell现象的结果如何，都应在上睑下垂手术后监测夜间睁眼。胶带眼睑闭合可以是在夜间眩眼期间保护角膜表面的有效解决方案。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
方法：我们对2020年4月至2021年6月在西京医院接受不同手术技术治疗的23例上睑下垂和Bell's差现象患者进行了回顾性病例系列研究。我们评估了不同睡眠阶段的贝尔现象，并收集了下垂程度的数据，手术方法,眼球，并发症,和结果。
结果：在最初考虑研究的23例患者中，9用额肌推进技术，8带联合筋膜鞘悬吊，4采用提上肌切除术技术，2采用提上肌腱膜折叠技术。所有患者均获得满意的下垂矫正。一名患者眼球下垂延长，并接受了再次手术以降低眼睑高度。其他并发症较小，经保守治疗可缓解。
结论：我们得出的结论是，不良的贝尔现象不是上睑下垂手术的相对禁忌症。无论Bell现象的结果如何，都应在上睑下垂手术后监测夜间睁眼。胶带眼睑闭合可以是在夜间眩眼期间保护角膜表面的有效解决方案。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
