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JAMA Patient Page
November 16, 2021

Bell Palsy

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham
  • 2Transitional Year Program, Brookwood Baptist Health, Birmingham, Alabama
JAMA. 2021;326(19):1983. doi:10.1001/jama.2021.18504

Bell palsy is a form of facial weakness or paralysis that typically affects one side of the face.

Bell palsy is a result of inflammation and dysfunction of the facial nerve (the seventh cranial nerve). Although the exact cause of Bell palsy is not known, there is evidence that it may be related to viral infections. Some viruses associated with Bell palsy are those that cause cold sores (herpes simplex virus), chickenpox/shingles (varicella zoster virus), mononucleosis (Epstein-Barr virus and cytomegalovirus), and respiratory infections (common cold viruses and influenza).

Additional risk factors associated with developing Bell palsy include pregnancy, obesity, diabetes, and a family history of Bell palsy.

Symptoms of Bell Palsy

Symptoms of Bell palsy typically appear quickly over 2 to 3 days. Common symptoms include facial drooping, drooling, difficulty closing the eye on the affected side of the face (and associated dryness or tearing), and difficulty smiling.

Less common symptoms include pain in the jaw or ear on the affected side, headache, increased sensitivity to loud sounds on the affected side, and loss of taste.

Although Bell palsy typically affects only one side of the face, in rare cases both sides can be affected. For many patients, symptoms begin to improve within 2 weeks and resolve over 2 to 3 months. Although most cases of Bell palsy resolve completely, some patients experience residual complications including

  • Permanent muscle weakness on one side of the face

  • Impaired vision from excessive corneal dryness and damage

  • Involuntary movements or twitching of one side of the face

  • Tearing while eating or drinking due to abnormal nerve recovery

It is important to seek immediate medical attention for any symptoms of facial weakness or paralysis because these could be signs of other medical conditions, such as a stroke, especially if other neurologic symptoms are present.

Treatment of Bell Palsy

The main treatment for Bell palsy is oral corticosteroids to reduce inflammation and increase the likelihood of facial nerve recovery. In addition to corticosteroids, antiviral agents may be prescribed, but they should not be used alone. Combination treatment with corticosteroids and antiviral agents is typically reserved for severe cases with obvious facial asymmetry at rest.

Bell palsy can limit the ability to blink, which can lead to painful eye irritation and dryness and may in rare instances cause permanent corneal damage and vision problems. For patients experiencing incomplete eyelid closure because of Bell palsy, treatments include daytime use of lubricating eye drops and, during sleep, either using a lubricating ointment for the eye or placing tape over the eyelid. If the eyelid still does not close completely after recovery from Bell palsy, eyelid surgery may be an option.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Zhang W, Xu L, Luo T, et al. The etiology of Bell’s palsy: a review. J Neurol. 2020;267(7):1896-1905. doi:10.1007/s00415-019-09282-4

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