Bell Palsy
Also known as Facial nerve palsy, Idiopathic facial paralysis
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is bell palsy?
Bell palsy is sudden weakness or paralysis of one side of the face caused by inflammation of the facial nerve. It develops over hours to days and most people recover substantially, particularly when treated early with corticosteroids. The critical first step is distinguishing it from stroke, because the treatment and urgency differ completely.
Causes
- Inflammation and swelling of the facial nerve
- Reactivation of herpes simplex virus in many cases
- Varicella zoster virus in Ramsay Hunt syndrome
- Often no identifiable trigger
Symptoms
- Rapid onset weakness of one side of the face
- Inability to close the eye or raise the eyebrow on the affected side
- Drooping of the mouth corner and drooling
- Loss of the nasolabial fold
- Altered taste
- Sensitivity to sound in one ear
- Pain around the jaw or behind the ear
Risk factors
- Pregnancy, especially the third trimester
- Diabetes
- Recent upper respiratory infection
- Family history in a minority of cases
Diagnosis
- Clinical examination confirming forehead involvement
- Exclusion of stroke, which typically spares the forehead
- Examination of the ear for zoster vesicles
- Blood glucose testing
- Imaging or Lyme serology when the presentation is atypical
Treatment
- Oral corticosteroids started within 72 hours of onset
- Antiviral medicine added in severe cases or suspected zoster
- Eye protection with lubricating drops and taping at night
- Facial exercises and physiotherapy during recovery
- Specialist referral if no recovery by three months
Self care
- Use lubricating eye drops through the day
- Tape or patch the eye closed at night to protect the cornea
- Wear sunglasses outdoors
- Chew carefully and take smaller mouthfuls
- Practise gentle facial exercises in front of a mirror
- Take steroids exactly as prescribed and complete the course
When to see a doctor
Book an appointment if:
- No improvement after three weeks
- Eye becoming red, painful or gritty
- Worsening weakness after the first few days
- Facial twitching or tightness during recovery
- Hearing changes or ear pain
- Difficulty eating or drinking
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- No reliable prevention exists for most cases
- Manage diabetes well, which is an associated risk factor
- Seek care within 72 hours of onset for best outcome
- Shingles vaccination reduces the risk of Ramsay Hunt syndrome
Outlook
Most people improve within two to three weeks and recover fully or nearly fully by three to six months, particularly when corticosteroids are started within 72 hours. A minority are left with residual weakness, altered tear production or facial synkinesis. Eye protection during the recovery period is what prevents lasting corneal damage.
Common questions
How is Bell palsy told apart from a stroke?
In Bell palsy the forehead is weak, so the person cannot raise the eyebrow or wrinkle the forehead on that side. A stroke usually spares forehead movement. Any sudden facial weakness should be assessed urgently rather than assumed to be Bell palsy.
Will the face return to normal?
Most people improve within two to three weeks and recover substantially by three to six months, particularly with early steroid treatment. A minority are left with some residual weakness.
Why is eye care emphasised?
If the eye cannot close fully the cornea can dry out and ulcerate. Lubricating drops during the day and taping the eye closed at night protect vision while nerve function recovers.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.