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Sir, Rossiter _et al_1 have written a timely reminder of the problems that may result from Bell's reflex in the nonparalysed patient undergoing cataract surgery under general
anaesthesia. Bell's reflex can also be a problem in strabismus surgery leading to difficulties in interpretation of the forced duction test and impeding access to the extraocular
muscles.2, 3 In a recent survey carried out in the Southwest of England, neuromuscular blocking agents were used in only 45% of children and 34% of adults undergoing strabismus surgery.4 The
authors point out that conditions for forced duction test and ocular access may be less than ideal in a large proportion of patients undergoing strabismus surgery. In paediatric ptosis
surgery, it is necessary to set the height of the eyelid relative to the pupil under general anaesthetic.5 For this, the patient must be paralysed to abolish Bell's reflex at least
until the levator muscle has been sutured into place. REFERENCES * Rossiter JD, Wood M, Lockwood A, Lewis K . Operating conditions for ocular surgery under general anaesthesia: an eccentric
problem. _Eye_ 2006; 20(1): 55–58. Article CAS Google Scholar * Castanera de Molina A, Giner Munoz ML . Ocular alignment under general anesthesia in congenital esotropia. _J Pediatr
Ophthalmol Strab_ 1991; 28(5): 278–282. CAS Google Scholar * Harrad R . Strabismus Surgery. In: Easty D, Sparrow J (eds). _Oxford Textbook of Ophthalmology_. Oxford University Press:
Oxford, 1999, p 1242. Google Scholar * Dell R, Williams B . Anaesthesia for strabismus surgery: a regional survey. _Br J Anaesth_ 1999; 82(5): 761–763. Article CAS Google Scholar * Tyers
A, Collin J . _Colour Atlas of Ophthalmic Plastic Surgery_, 2nd edn. Butterworth Heinemann: London, 2001, p 161. Google Scholar Download references AUTHOR INFORMATION AUTHORS AND
AFFILIATIONS * Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK R A Harrad & P Stoddart Authors * R A Harrad View author publications You can also search for this author
inPubMed Google Scholar * P Stoddart View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to R A Harrad. RIGHTS AND
PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Harrad, R., Stoddart, P. Operating conditions for ocular surgery under general anaesthesia: an eccentric problem.
_Eye_ 21, 256–257 (2007). https://doi.org/10.1038/sj.eye.6702487 Download citation * Published: 16 June 2006 * Issue Date: 01 February 2007 * DOI: https://doi.org/10.1038/sj.eye.6702487
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