Evaluation Of The Cornea

    Candidates are routinely tested for Bell's phenomenon and corneal staining. Corneal sensation is tested in selected patients whose corneas stain.

    The examiner tests for Bell's phenomenon by having the patient tightly close the eyelids. The examiner then pries the eyelids open slightly and notes the position of the cornea and iris. Normally, the eye will elevate. If not, the patient may have a potential for ocular irritation after tightening the eyelids, and the surgery should be conservative or not performed at all. Certainly, patients should be warned of this possibility preopera¬tively because they may have to use artificial tears or ocular ointment for the rest of their lives.


    Corneal sensation is tested while the patient gazes slightly upward. The examiner pulls up a wisp of cotton from a cotton applicator and touches the peripheral cornea with it. No response or a minimal response is abnormal, and surgery is contraindicated because of the possibility of postoperative corneal problems.

    Fluorescein applied to the inferior cul-de-sac allows the examiner to study the cornea for staining under the cobalt blue light of the slit lamp. Marked keratopathy can be expected to increase after cosmetic eyelid surgery. Affected patients should not have surgery unless the keratopathy is minimal; even if it is minimal, the skin and fat should be resected very conservatively and the patient should be warned preoperatively of the possibility of postoperative ocular irritation and long-term need for ocular lubricants. The same is true for patients with blepharoptosis.