What is the treatment for Bell's palsy?

Treatment for Bell's Palsy

Oral corticosteroids should be prescribed within 72 hours of symptom onset as the first-line treatment for Bell's palsy in patients 16 years and older. 1, 2

First-Line Treatment

• Recommended corticosteroid regimens:

  • Prednisolone 50 mg daily for 10 days, OR
  • Prednisone 60 mg daily for 5 days followed by a 5-day taper 1, 2

• Strong evidence supports corticosteroid use, with 83% recovery at 3 months with prednisolone vs 63.6% with placebo, and 94.4% recovery at 9 months with prednisolone vs 81.6% with placebo 1, 3

• Treatment must be initiated within 72 hours of symptom onset for maximum effectiveness 1, 4

Eye Protection

• Implement eye protection for all patients with impaired eye closure to prevent corneal damage 1, 2

• Eye protection methods include:

  • Lubricating ophthalmic drops used frequently throughout the day 1
  • Ophthalmic ointments for more effective moisture retention, particularly at night 1
  • Moisture chambers using polyethylene covers for nighttime protection 1
  • Eye patching or taping with careful instruction on proper technique 1
  • Sunglasses for outdoor protection 1

Antiviral Therapy

• Antiviral therapy alone should NOT be prescribed for Bell's palsy 1, 2, 3

• Combination therapy with oral antivirals and corticosteroids may be offered within 72 hours of symptom onset as an option 1, 2

  • Some evidence shows higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 2
  • Recommended antivirals include valacyclovir (1 g three times daily for 7 days) or acyclovir (400 mg five times daily for 10 days) 5

Special Populations

• Children have better prognosis with higher rates of spontaneous recovery (up to 90%) 1, 5

• Pregnant women should be treated with oral corticosteroids within 72 hours of symptom onset, with individualized assessment of benefits and risks 1

Follow-up and Monitoring

• Patients should be reassessed or referred to a facial nerve specialist if:

  • New or worsening neurologic findings develop 1, 2
  • Ocular symptoms develop 1, 2
  • Incomplete facial recovery persists 3 months after initial symptom onset 1, 2

• MRI with and without contrast is the imaging test of choice when indicated (atypical presentations, no recovery after 3 months, worsening symptoms) 1

Recovery Timeline

• Approximately 70% of patients with complete paralysis recover facial function completely within 6 months without treatment 1, 6

• Patients with incomplete paralysis have higher recovery rates, up to 94% 1

• Most patients begin showing signs of recovery within 2-3 weeks of symptom onset 1

• Complete recovery typically occurs within 3-4 months for most patients 1

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours reduces effectiveness of therapy 1, 2

• Using antiviral therapy alone is ineffective 1, 2, 3

• Failing to provide adequate eye protection for patients with impaired eye closure, which can lead to corneal damage 1

• Improper eye taping technique can cause corneal abrasion 1

• Relying solely on drops without nighttime protection can lead to exposure keratitis 1

• Delaying specialist referral for patients with severe or persistent symptoms 1