Idiopathic Facial Paralysis / Facial nerve palsy / Bell’s Palsy
-Prednisone 60mg po daily x 7 days.
-Valacyclovir 1g po TID x 7 days.
-Artificial tears (Liquid or gel formulation) – E.g. Gonak (2.5% Sterile Hypromellose Ophthalmic Demulcent Solution. Apply every hour while the patient is awake.
-Artificial tears (ointment formulation) – E.g. Lacri-Lube ophthalmic ointment which contains mineral oil and white petrolatum, should be used at night. Another brand name is Soothe.
-Protective glasses or goggles have been prescribed.
-Patches can be used at night, but tape should not be placed directly on the eyelid to avoid abrasion.
-F/u in 2 weeks.
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Botox injections may be helpful for patients with incomplete recovery.
The suspicion that Bell’s palsy is caused by herpes simplex virus in most patients is why antivirals like Acyclovir and Valacyclovir are used.
Herpes zoster oticus (Ramsay Hunt syndrome) may be associated.
References
Am Fam Physician. 2014 Feb 1;89(3):209-212. http://www.aafp.org/afp/2014/0201/p209.html.