What is the immediate treatment for a patient diagnosed with Bell's palsy?

Immediate Treatment for Bell's Palsy

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

First-Line Treatment

• The recommended corticosteroid regimen is either:

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

• Early corticosteroid treatment significantly improves outcomes:

  • 83% recovery at 3 months with prednisolone vs. 63.6% with placebo
  • 94.4% recovery at 9 months with prednisolone vs. 81.6% with placebo 2

• Treatment must be initiated within 72 hours of symptom onset for maximum effectiveness 1, 3

Combination Therapy Considerations

• Antiviral monotherapy should NOT be prescribed for Bell's palsy as it is ineffective 1, 2, 4

• Combination therapy with oral antivirals plus corticosteroids may be considered within 72 hours of symptom onset:

  • Some evidence shows higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 1, 5
  • Options include valacyclovir (1 g three times daily for 7 days) or acyclovir (400 mg five times daily for 10 days) 4, 5

Eye Protection (Critical)

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

• Eye protection measures include:

  • Frequent lubricating ophthalmic drops during the day 2
  • Ophthalmic ointments for nighttime protection 2
  • Moisture chambers, eye patching/taping with proper technique 2
  • Sunglasses for outdoor protection 2

Special Populations

• Children have higher rates of spontaneous recovery than adults, but corticosteroids should still be considered 1, 2

• Pregnant women should receive corticosteroids within 72 hours, with individualized assessment of benefits and risks 2

Follow-up and Monitoring

• Reassess or refer to a facial nerve specialist if:
  • New or worsening neurologic findings develop at any point
  • Ocular symptoms develop
  • Incomplete facial recovery persists 3 months after initial symptom onset 1, 2

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours significantly reduces effectiveness 1, 3

• Using antiviral therapy alone is ineffective and not recommended 1, 2

• Failing to provide adequate eye protection can lead to corneal damage 1, 2

• Routine laboratory testing and imaging are not required for typical presentations of Bell's palsy 2

• Failing to rule out other causes of facial weakness before diagnosing Bell's palsy 1, 2