Bell’s Palsy

Ocular symptoms of Bell’s palsy include an inability to close the eye on the affected side leading, dryness, redness, and a burning sensation of the eye. 

Last Updated: March 27, 2023

What is Bell’s palsy?

Bell’s palsy is a condition that results from a weakness or paralysis of the facial nerve, commonly affecting half of the face from the forehead to the chin. The prevalence of Bell’s palsy is approximately 10-20 in every 100,000 people, generally affecting individuals between the ages of 15 to 45.1-3

Symptoms of Bell’s palsy may include facial asymmetry, facial muscle weakness, facial numbness, slurred speech, difficulty chewing, drooling, drooping of one corner of the mouth, altered taste, increased sensitivity to sound, and facial pain. Ocular symptoms of Bell’s palsy include an inability to close the eye on the affected side leading, dryness, redness, and a burning sensation of the eye. If you experience these symptoms, seek attention from your optometrist.

What are the causes of Bell’s palsy?3-5

Bell’s palsy is mostly idiopathic, meaning that the cause is unknown. However, several conditions can be linked to Bell’s palsy such as the following: viral infections (herpes, flu, chicken pox, shingles, Epstein-Barr), bacterial infections, Lyme disease, inflammation of the facial nerve (sarcoidosis), diabetes, hypertension, pregnancy, multiple sclerosis, injuries, facial or dental surgeries, and exposure to extreme cold.

Bell’s Palsy

Photo: Bell’s Palsy

How does Bell’s palsy affect the eye?

Blinking is required to keep the surface of the eye lubricated, allowing for clear vision and a comfortable healthy state of the eye. Individuals with Bell’s palsy are unable to blink the eye on the affected side. This causes the surface of the eye to dry out, leading to blurry vision, discomfort and redness of the eye. If left untreated, it can result in exposure keratopathy, corneal scarring, secondary infections, and even vision loss.4

How is Bell’s palsy treated?4

Most cases of Bell’s palsy occur rapidly and symptoms reach their peak by 72 hours. In 70% of cases, spontaneous recovery generally follows in 2-3 weeks leading to a complete recovery in 3-6 months. Less commonly, longer periods of recuperation and individuals over the age of 60 are at a greater risk of being left with long-term effects of Bell’s palsy.

The severity of symptoms affecting Bell’s palsy varies greatly and treatment options are aimed at maintaining quality of life by limiting disfigurement and protecting vision. Additional testing with MRI, CT, or EMG may be warranted to help reveal the underlying cause of Bell’s palsy. To manage the ocular symptoms and maintain good vision, conservative treatment includes the use of eye drops and ointments to keep the surface of the eye lubricated. Eye patch, goggles, or taping the eyelids shut during sleep can offer relief and corneal protection. If conservative methods fail, botox injections can be used to treat exposure keratopathy and facial symmetry. In more severe or long lasting cases of Bell’s palsy, surgical options such as gold weight implant or tarsorrhaphy to close the lids may be considered. Over the counter pain medication may be considered if necessary.

If you are experiencing symptoms of Bell’s palsy, book an appointment with your local optometrist.

References

  1. Baugh RF et al. Clinical practice guideline: Bell’s palsy. J Otolaryngol - Head N. 2013;149(3):S1-S27.
  2. Pieterson E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002;549:4-30.
  3. Holland NJ et al. Recent developments in Bell’s palsy. Br Med J. 2004;329(7465):553-557.
  4. Rahman I et al. Ophthalmic management of facial nerve palsy: a review. Surv Ophthalmol. 2007;5292):121-144.
  5. Zhang W et al. The etiology of Bell’s palsy: a review. J Neurol. 2020;267:1896-1905.
     

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