Understanding Bell’s Palsy

When the facial nerve becomes swollen inside a narrow bone tunnel in your skull, it cannot send signals to your facial muscles properly. This inflammation happens quickly and causes one side of your face to droop or become paralyzed.

• One side of your face droops or feels stiff
• You cannot close your eye completely on the affected side
• Your smile becomes crooked or lopsided
• You may drool or have trouble keeping food in your mouth

The facial nerve does much more than control facial expressions. It also helps with tear production, taste sensation on the front of your tongue, and controls a small muscle in your ear that protects against loud sounds. This is why Bell's palsy can cause problems with your eyes, taste, and hearing in addition to facial weakness.

Bell's palsy can happen to anyone at any age, but it most commonly affects people between ages 15 and 45. About 20 to 30 people per 100,000 develop this condition each year. Both men and women are equally likely to get Bell's palsy.

Certain health conditions can increase your chances of developing Bell's palsy:

• Diabetes or high blood pressure
• Pregnancy, especially in the third trimester, or recently after giving birth
• Upper respiratory infections like colds or flu
• Being overweight or having a weak immune system
• Living in areas where Lyme disease is common

Bell's palsy causes weakness of your entire face including your forehead, while stroke usually spares forehead movement and causes other symptoms like arm or leg weakness. However, some rare brain stem strokes can look similar to Bell's palsy. Shingles affecting the facial nerve causes a painful rash with blisters around your ear or mouth, which is different from typical Bell's palsy.

Bell's palsy is not contagious and cannot be passed from person to person. Weakness on both sides of your face at the same time is extremely rare and suggests other medical conditions that need different treatment. Understanding these differences helps ensure you get the right diagnosis and treatment.

When the facial nerve stops working properly, the muscles that close your eyelid become weak or paralyzed. This leaves your eye open and exposed, even when you try to close it. Without the natural protection of blinking, your eye quickly becomes dry and irritated.

Normal blinking spreads tears across your eye to keep it moist and healthy. When you cannot blink properly, your eye becomes dry and uncomfortable very quickly:

• Burning, stinging, or gritty feeling in your eye
• Blurred vision that comes and goes
• Redness and irritation that gets worse during the day
• Feeling like sand or an eyelash is stuck in your eye

The clear front part of your eye, called the cornea, can get scratched or develop an ulcer when it stays dry for too long. This condition, called exposure keratitis, can cause permanent vision problems if not treated right away. Corneal ulcers are particularly dangerous and need emergency treatment to save your vision.

Even though your eye may be dry, you might also notice excessive tearing that runs down your cheek. This happens because your eyelid cannot control the tears properly, so they overflow instead of staying on your eye surface where they are needed.

Some eye symptoms require immediate medical attention to protect your vision:

• Severe eye pain or sharp, stabbing discomfort
• Sudden changes in your vision or blurred sight
• Bright red eye with discharge or increased pain
• Extreme sensitivity to light that prevents normal activities
• White or gray spot on the colored part of your eye

About 70% of people recover completely from Bell's palsy, especially with early treatment and proper eye care. Even if you have some lasting effects, treatments are available to improve symmetry and function. Children and people with milder initial weakness have the best chance of complete recovery.

Treatment should begin as soon as possible, ideally within 72 hours of when symptoms started. Early steroid treatment significantly improves your chances of recovery. Eye protection should start immediately, even before seeing a doctor.

The evidence for antiviral drugs is not clear, and many experts recommend steroids alone as the best treatment. When antivirals are used, they are combined with steroids and should never be used as the only treatment for Bell's palsy.

Use preservative-free artificial tears frequently during the day and thick lubricating ointment at bedtime. Gently tape your eyelid closed or use an eye patch while sleeping if your eye does not close completely. Wear protective glasses outdoors and avoid windy or dusty conditions.

Moisture chambers are special goggles that keep your eye moist and may be more comfortable than taping for some patients. They are especially helpful for people with sensitive skin or those who need protection during the day while working or being active.

Facial weakness has been reported after COVID-19 infection and rarely after vaccination, but these associations are not proven to be caused by the virus or vaccine. Regardless of the potential trigger, treatment remains the same with early steroids and eye protection.

Most people with typical Bell's palsy do not need blood tests or imaging studies. Testing may be needed if symptoms are unusual, occur on both sides, or do not improve as expected over time. In areas where Lyme disease is common, blood tests may be recommended.

If weakness persists after three months, our eye doctors may recommend facial physical therapy, botulinum toxin injections for unwanted muscle movements, or surgical procedures to improve eye protection or facial symmetry. Many effective treatments are available for lasting effects.

Gentle, supervised facial therapy can help coordination as movement returns, but forceful or unsupervised exercises during the early recovery period may worsen outcomes. Wait for guidance from our eye doctors before starting any exercise program.

Most people begin seeing improvement within two to three weeks, with continued recovery over three to six months. More severe initial weakness may take longer to recover, but improvement can continue for up to a year.

Recurrence happens in about 5 to 15% of people over their lifetime, usually years later. If you develop facial weakness again, especially on the same side, contact our office promptly as this may indicate other conditions that need investigation.

No, Bell's palsy itself is not contagious and cannot be passed from person to person. While viruses may trigger the condition, the facial weakness itself does not spread to others.

Recovery typically follows a pattern where weakness peaks in the first few days, stays stable for one to two weeks, then gradually improves over months. Eye symptoms usually improve before facial movement returns, and some people may experience muscle twitching or tightness as the nerve heals.

Synkinesis is when facial muscles move together when you do not want them to, like your eye closing when you smile. This affects about 25% of people after Bell's palsy and can be treated with specialized physical therapy and botulinum toxin injections to reduce unwanted movements.

Pregnant women and those who recently gave birth have a higher risk of developing Bell's palsy. Recovery can vary in this group, making proper eye protection especially important. Treatment decisions during pregnancy require careful consideration of benefits and risks.

The facial nerve controls a small muscle in your ear that normally protects against loud sounds. When this nerve is not working, everyday sounds may seem uncomfortably loud. This condition, called hyperacusis, usually improves as the nerve heals.

Weakness on both sides of your face at the same time is extremely rare and is usually not Bell's palsy. This symptom suggests other medical conditions that need immediate evaluation and different treatment approaches.