1.8 Facial Palsy (Bell's Palsy)

eyes.nhs.scot/
Eyecare Guidelines/
Section 1 - Eyelids/
1.8 Facial Palsy (Bell's Palsy)

Date of last review: Due to be updated

Differential diagnosis

Stroke
Sarcoidosis
Lyme disease
Complication of Otitis media
Trauma
Tumour
Ectropion
Entropion
Thyroid eye disease

Possible management by Optometrist

Treatment

Tear supplements (lubricants by day, unmedicated ointment at night)
Horizontally tape lids closed at night (and during day if corneal desiccation is marked and corneal sensation intact)
Therapeutic contact lens (if unresponsive to frequent use of ocular lubricants)

Check corneal sensation is intact (do not use if impaired)
Silicone hydrogel should be considered as first choice (however, scleral lens gives maximum protection)

Sunglasses for photophobia and general protection
Urgent referral to GP for consideration of systemic steroids:

Prednisolone 25 mg twice daily for 10 days, or
Prednisolone 60 mg daily for five days followed by a daily reduction in dose of 10mg (for a total treatment time of 10 days), if a reducing dose is preferred

Advice

Most cases resolve spontaneously within 9 months
May respond to systemic steroids in the acute phase (first 3 days)

Management Category

Urgent referral to GP for systemic steroids
Normally no referral to ophthalmology
Emergency (same day) referral if corneal ulceration present

Possible management by Ophthalmologist

As above
Upper lid lowering with botulinum toxin injection of levator muscle
Surgery for permanently unrecovered cases
External lid weights

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