What are the recommended eye drops for patients with Bell's palsy?

Eye Care for Bell's Palsy Patients

Lubricating ophthalmic drops should be the primary eye protection method for Bell's palsy patients with impaired eye closure, supplemented with ophthalmic ointments at night for more effective moisture retention. 1

Eye Protection Recommendations

Bell's palsy can lead to incomplete eyelid closure (lagophthalmos), which puts patients at significant risk for corneal damage. This occurs due to:

• Upper eyelid retraction or lower lid ectropion
• Failure of the lacrimal pump mechanism
• Decreased blink and tear production
• Loss of the corneal "squeegee effect" on the affected side

Without proper eye protection, patients may develop:

• Foreign particle deposition in the eye
• Corneal abrasions
• Exposure keratitis
• Corneal ulcerations

First-Line Eye Protection Measures

1. Lubricating Ophthalmic Drops:

   • Apply 1-2 drops in the affected eye as needed throughout the day 1, 2
   • Advantages: Add hydration, prevent moisture loss, don't blur vision
   • Limitation: Require frequent application

2. Ophthalmic Ointments:

   • Apply at night when blurring of vision is less problematic
   • Advantages: Require less frequent application, more effective at preventing moisture loss
   • Limitation: Tend to blur vision

3. Additional Protective Measures:

   • Sunglasses for daytime protection
   • Moisture chambers using polyethylene covers
   • Eye patching or taping (particularly effective at night)
   • Note: Patients should receive careful instruction on proper execution of eye taping/patching to avoid corneal damage 1

Management Algorithm

For Mild to Moderate Impairment:

• Daytime: Frequent lubricating eye drops + sunglasses
• Nighttime: Ophthalmic ointment + moisture chamber or careful taping

For Severe Impairment or Treatment Failure:

Refer for detailed ophthalmologic evaluation for consideration of:

• Botulinum toxin injections (temporary improvement of eyelid closure)
• Temporary or permanent tarsorrhaphy
• Surgery to weight the upper eyelid 1

Monitoring and Follow-Up

Clinicians should be vigilant for symptoms indicating corneal complications:

• Burning sensation
• Itching
• Eye irritation
• Changes in vision
• Eye pain 1

Patients with any of these symptoms should be promptly reassessed or referred to a specialist.

Important Considerations

• Eye protection is a strong recommendation based on expert opinion and clinical rationale 1
• Bell's palsy patients should be reassessed or referred to a facial nerve specialist if ocular symptoms develop at any point 1
• The majority of Bell's palsy patients recover spontaneously within three weeks to three months 3, 4
• Early and appropriate eye care is critical to prevent permanent corneal damage while awaiting recovery

Remember that while Bell's palsy treatment typically includes oral steroids (and possibly antivirals), eye protection remains a crucial component of management to prevent potentially serious ocular complications during the recovery period.