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Hashemi Eye Care - Neuroscience Institute and Research Center

Bell's Palsy

Sudden facial weakness affecting one side of the face, including eye closure. Learn about causes, eye care, and recovery expectations.

6 min read

Bell's palsy is sudden weakness or paralysis of the facial nerve (cranial nerve VII) affecting one side of the face. It impacts the ability to close the eye, raise the eyebrow, and move the mouth on the affected side. While alarming, most people recover fully.

Key Takeaways

  • Sudden facial weakness affecting one side of the face
  • Eye protection is critical—inability to close the eye can damage the cornea
  • Most people recover well, often within weeks to months
  • Early steroid treatment improves outcomes
  • Not caused by stroke—but stroke must be ruled out in some cases

Medical illustration of Bell's palsy showing facial asymmetry with one side having a drooping mouth, flattened forehead, and inability to fully close the eye compared to the normal side

Symptoms

Facial Weakness

  • Weakness develops over hours to 1-2 days
  • Affects one side of the face
  • Inability to:
    • Close the eye
    • Raise the eyebrow
    • Smile on the affected side
    • Puff out the cheek

Other Symptoms

  • Pain behind the ear (often precedes weakness)
  • Decreased taste
  • Sensitivity to loud sounds
  • Drooling
  • Difficulty eating and drinking

What Causes Bell's Palsy

Suspected Cause

  • Viral inflammation of the facial nerve
  • Likely caused by herpes simplex virus reactivation
  • Nerve swells within its bony canal, causing compression

Risk Factors

  • Diabetes
  • Pregnancy (especially third trimester)
  • Upper respiratory infection
  • Weakened immune system

Conditions to Rule Out

Bell's palsy is a diagnosis of exclusion. Other causes of facial weakness must be considered:

  • Stroke (if forehead is spared, seek emergency evaluation)
  • Lyme disease
  • Tumors
  • Ramsay Hunt syndrome (shingles affecting the ear)
  • Other infections

Eye Care in Bell's Palsy

Why Eye Protection Is Critical

When you can't close your eye:

  • Cornea dries out and can be damaged
  • Risk of corneal ulcer and scarring
  • Can cause permanent vision loss if untreated

Protective Measures

Daytime:

  • Artificial tears frequently (every 1-2 hours)
  • Gel drops for longer-lasting moisture
  • Wrap-around glasses to reduce evaporation

Nighttime (most important):

  • Lubricating ointment before bed
  • Tape eyelid closed (paper tape)
  • Moisture chamber or plastic wrap
  • Sleep on the unaffected side

If symptoms of corneal damage occur:

Medical/Surgical Options for Eye

  • Temporary eyelid weights (stick-on or surgical)
  • Botox to lower upper lid
  • Temporary tarsorrhaphy (partial eyelid closure)
  • Gold weight implant (if prolonged paralysis)

Treatment

Steroids

  • Prednisone started within 72 hours of onset
  • Improves recovery rates
  • Usually 10-14 day course with taper
  • Most important early treatment

Antivirals

  • Often prescribed with steroids
  • Valacyclovir or acyclovir
  • Evidence for benefit is less clear than steroids
  • Typically given for suspected viral cause

Physical Therapy

  • Facial exercises
  • Massage
  • May help with recovery
  • Especially useful if recovery is incomplete

Prognosis and Recovery

Recovery Timeline

  • Most improvement occurs within 3 weeks
  • Recovery continues for up to 6 months (or longer)
  • 70-80% recover completely without treatment
  • With early steroids, >90% have good recovery

Signs of Recovery

  • Twitching of facial muscles
  • Return of movement (often forehead first)
  • Gradual improvement in eye closure

Incomplete Recovery

Some patients may experience:

  • Residual weakness
  • Synkinesis (unintended movements, like eye closing when smiling)
  • Crocodile tears (tearing while eating)
  • Facial tightness

Living with Bell's Palsy

First Few Weeks

  • Focus on eye protection
  • Complete steroid course
  • Rest
  • Be patient—recovery takes time

Eating and Drinking

  • Food may collect in affected cheek
  • Drinking may be difficult (liquid escapes)
  • Eat slowly, smaller bites
  • Use a straw for liquids

Emotional Impact

  • Facial changes can be distressing
  • Social anxiety is common
  • Recovery is usually good—focus on this
  • Support groups may help

Frequently Asked Questions

Is Bell's palsy a stroke?

No, Bell's palsy is not a stroke. However, facial weakness can be a stroke symptom. Key difference: In Bell's palsy, the entire half of the face is weak (including forehead). In stroke, typically only the lower face is affected (forehead is spared). If you're unsure, seek emergency evaluation.

How long will it last?

Most people see significant improvement within 3 weeks and near-complete recovery within 3-6 months. A small percentage may have permanent residual weakness.

Can Bell's palsy happen again?

About 7-12% of people experience recurrence, sometimes on the opposite side. Recurrence should prompt additional testing to rule out other causes.

Should I see a neurologist?

An initial evaluation is often done by a primary care doctor or emergency physician. If symptoms are atypical, not improving, or recurrent, neurological evaluation is recommended.

Why is eye care so important?

The cornea must stay moist to remain healthy. Without the ability to blink and close the eye, the cornea can dry out, develop ulcers, scar, and even perforate. This can cause permanent vision loss—but is preventable with proper care.

Can I drive?

If your eye closes properly (even partially) and your vision is good, driving is usually possible. If you cannot close your eye, you may have difficulty with wind and glare. Discuss with your doctor.

References

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