Bell’s Palsy and Facial Paralysis

September 6, 2013

Bells Palsy Image of facial muscles and nerves

Your appearance and facial expression depend on the normal action of the muscles in your face.  Sudden paralysis (palsy) of the facial muscles – called Bell’s palsy – is a fairly common condition that affects one side of the face and can prevent you from moving most of the muscles on that side. If the loss is only partial, it is called a paresis instead of a palsy, but the problem is essentially the same.

Symptoms of Bell's Palsy

Bells palsy

What usually happens is that you awaken one morning and feel that one side of your face is “funny” or not moving right.  When you look in the mirror, you see that one eye is staring – not blinking normally – and that the corner of your mouth sags on that side.

Over the next few days this may worsen, your eye may feel scratchy and teary, and vision on that side may be blurred.  The lower eyelid may sag or droop.  The skin on that side of your face may become somewhat numb.

How Serious is Bell’s Palsy?

Along with the problem of not being able to move your lips very well for talking and eating, you will lose part or all of the ability to close or blink the eyelids on the affected side.

Blinking is far more important than most people realize.  For proper functioning, the eye requires a continuous flow of moisture over its surface.  Each time you blink, the upper eyelid sweeps across the eye like a windshield wiper and spreads your tears smoothly over the cornea (the focusing surface of the eye).

If you can’t blink, the cornea dries out and its cells begin to die.  If left dry for too long, a corneal ulcer may form, and if the ulcer should become infected, the result may be scarring or even perforation of the cornea, which can lead not only to loss of vision, but even to loss of the eye itself.  Thus, in addition to the change in facial appearance, it is important to understand that eyesight is also very much endangered.

 What Causes Bell’s Palsy?

The muscles in your face are controlled by the facial nerve.  When the facial nerve becomes inflamed, as from a virus infection, it loses the ability to control the facial muscles.  This is the most common cause of a Bell’s palsy.

Many other conditions can affect your facial nerve.  The more serious ones include tumors of the salivary gland, problems in the inner ear, infections, and various neurological conditions and tumors, but all of these are rare.

 Treatment for Bell's Palsy

Bell’s palsy often heals on its own over the next few weeks or months.  Any treatment for the paralysis will depend what has caused it.

In the meantime, it is important to prevent corneal drying and ulceration.  Use artificial tears eyedrops and/or a lubricating ointment in your eye frequently, as often as every 15 to 30 minutes if necessary.  At bedtime, use liberal amounts of the ointment and spread it evenly by gently moving the eyelid around with your finger.  This will help prevent damage to the cornea, which is most likely to occur while you are sleeping because you are unaware of any discomfort caused by the drying.

If tears or ointment are inadequate to prevent corneal drying, you may need to tape the eyelids shut at night.  If so, use a small piece of hypo-allergenic paper tape to hold the lids closed.  You must be careful not to injure the cornea with the tape.  You will be shown how to apply the tape properly.

If these simple measures do not protect the cornea sufficiently, or if the paralysis becomes permanent, more stringent measures will be required.  Some patients are helped by having a “moisture chamber” placed over the eye, but the best treatment is minor surgery to attach the upper and lower eyelids together at each side, leaving a slit-like opening to look through.  This procedure is called a tarsorrhaphy.  Later, if the facial paralysis lessens or is corrected, the lids can be easily re-opened.

Remember, most of the time facial paralysis corrects itself in a few weeks or months.  In the interim, complete and adequate protection of the eyes from drying is essential and may require any or all of the treatment methods discussed above.  Ignoring the problem or delay in treating it can cause serious scarring of the cornea and eventual loss of sight.

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