Bell’s Palsy

You may have heard of Bell’s palsy but are not sure what the condition is. It is caused by a problem with nerves which affect the facial muscles. Bell’s palsy causes partial paralysis and weakness of muscles on just a single side of the face. People suffering from Bell’s palsy may have a smile that seems uneven, one half of their face droops, or one of their eyelids does not close normally.

Who is affected by Bell’s palsy?

Although it can happen at any age, most often Bell’s palsy affects adults rather than children. People with certain conditions have an increased likelihood of suffering from Bell’s palsy, including those with a family history of the condition, pregnant women, those with diabetes, and those with an upper respiratory infection.

Causes of Bell’s palsy

There is not clear evidence of the cause of Bell’s palsy. Many doctors suspect that the main factors include:

• A viral infection that causes facial nerves to swell
• A problem with the immune system
• A reduction in blood flow going to a specific nerve serving one side of the face

Symptoms of Bell’s palsy

The symptoms of Bell’s palsy can come on suddenly, often happening within a few hours to a few days. A person may have difficulty speaking clearly and may find it difficult to smile on just one side of their face. In addition, a person may have pain before their face loses feeling, becomes weak, or is partially paralyzed. They may also begin drooling. Paralysis of the upper eyelid muscle causes decreased blinking and inability to close the eye, which in turn causes dryness and discomfort for the person. Weakness of the lower eyelid muscle causes out-turning of the eyelid, called ectropion, which in turn interferes with tear drainage resulting in constant tearing from the effected eye.

Other senses can be affected as well, with a decrease in the ability to sense taste. Sounds might become distorted or sound unusual.

It is important to understand that Bell’s palsy almost always affects only one side of the face. Having symptoms affecting both sides can indicate a different, and potentially more severe, condition. If you have any of these symptoms it is important to contact your ophthalmologist or primary care doctor immediately. It is likely that they will recommend an MRI scan to image the affected tissues.

Length of symptoms

The majority of patients, about 80%, find that their symptoms are temporary and begin to improve after 3 weeks. Often they are minimal in 2 to 3 months. A few symptoms, including partial paralysis affecting one side of the face, may remain for a longer period of time. In about 20% of patients, symptoms of Bell’s palsy will remain for life.

If you find the symptoms affecting the eye to be uncomfortable, consult with your ophthalmologist to see what options are available.

Treatment for Bell’s palsy

While there is not a specific treatment, the symptoms of Bell’s palsy will disappear on their own in the majority of cases. Your doctor may prescribe antiviral drugs or corticosteroids to assist in healing. 

For symptoms affecting the eyes, your ophthalmologist will provide medical treatment, such as eye ointments or eye drops to help relieve discomfort caused by dry eye. If symptoms persist, surgical intervention might be required. Consultation with an Oculoplastic Surgeon is necessary if the eye does not close resulting in severe corneal dryness. Gold weight implantation into the upper eyelid and/or tightening of the lower eyelid are some of the procedures that can be offered to the patient whose symptoms are not resolving.