From the Guidelines
For Bell's palsy eye protection, supportive care consisting of ocular surface hydration with preservative-free artificial tears and ophthalmic ointments is strongly recommended. This is based on the clinical practice guideline for Bell's palsy, which emphasizes the importance of eye care in patients with impaired eye closure 1. The guideline suggests that clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure, with a strong recommendation based on expert opinion and a strong clinical rationale with a preponderance of benefit over harm.
Some key considerations for eye lubrication in patients with Bell's palsy include:
- Using preservative-free artificial tears every 1-2 hours during the day to prevent corneal dryness and exposure
- Applying lubricating ointment like Lacrilube or Refresh PM at night to provide longer-lasting hydration
- Taping the eye closed at night with paper tape if unable to fully close it, while ensuring proper execution to avoid corneal damage
- Considering the use of moisture chamber goggles during the day and a humidifier at night to maintain a humid environment and prevent dryness
These measures are crucial because Bell's palsy often affects the facial nerve, preventing complete eye closure (lagophthalmos), which can lead to corneal exposure, dryness, and potential ulceration or infection 1. If symptoms are severe, consulting an ophthalmologist may be necessary, who may recommend additional treatments such as temporary punctal plugs or a moisture chamber. It is essential to continue these protective measures until facial nerve function returns, which typically occurs within 3-6 months, and to watch for signs of corneal damage, including increased pain, redness, or vision changes, which require immediate medical attention.
From the Research
Eye Lubrication in Bell's Palsy
- The use of artificial tears is recommended for eye lubrication in patients with Bell's palsy, as reduced or absent orbicularis oculi function can result in lagophthalmos and exposure of the cornea 2.
- Initial management of exposure keratopathy consists of artificial tear drops and ointment for corneal lubrication, along with strategies to address the lagophthalmos 2.
- In addition to artificial tears, an occlusive bandage at nighttime may be used until the lagophthalmus is resolved 3.
- The goal of eye lubrication and other management strategies is to protect the ocular surface and prevent corneal breakdown, scarring, and permanent vision loss 2.
Treatment Approaches
- Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 4.
- Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 4.
- Physical therapy may be beneficial in patients with more severe paralysis 5.
Prognosis and Recovery
- More than two-thirds of patients with typical Bell's palsy have a complete spontaneous recovery 5.
- For children and pregnant women, the rate of complete recovery is up to 90% 5.
- With appropriate treatment, including eye lubrication and corticosteroids, patients with Bell's palsy can achieve a high rate of recovery 3, 5.