There is no curative treatment for Bell's palsy. Symptoms, especially in the eyes, are treated to prevent permanent damage. Treatment also attempts to reduce inflammation of the facial nerve.
Eye Care in Patients with Bell's Palsy
Bell's palsy usually affects the eye on the affected side of the face. Continuous eye care is required until the condition resolves. Patients are often unable to blink or close their eyelid completely, which can lead to eye problems and permanent damage, if the eye is not cared for properly.
Blinking and closing the eyelid helps move tears across the eye and into its drainage channels. Tears are continuously produced to maintain moisture in the eye, remove metabolic waste products and environmental debris (e.g., dust, ash), keep the eye's outer surface smooth, and deliver nutrients to underlying tissues.
When the eyelid is unable to blink or close, tears are not moved across the eye surface and the eye dries out. The closed eyelid holds moisture in and on the surface of the eye during sleep. If the lid does not close during sleep, the uncovered cornea is exposed to the environment. This causes dryness and possibly injury because of exposure to foreign bodies. Patients experience a gritty feeling in their eye, dryness, and burning.
Daytime treatment of the eye is relatively simple. Artificial tears are instilled about every 2 hours to keep the eye moist and patients can manually close the affected eye to keep moisture in and debris out. Sunglasses can help protect the eye from injury and reduce dryness by decreasing exposure to wind.
At night or during sleeping, a heavy lubricant is usually placed in the eye and the eyelid is taped shut to reduce dryness and the risk for injury.
Medications to Treat Bell's Palsy
Corticosteroids, such as prednisone, are used to reduce swelling and inflammation of the facial nerve. Whether or not this treatment speeds up healing and improves the chances for complete recovery has not been determined. Once the decision has been made to use corticosteroids, they should be started within 2 days after symptoms develop. Treatment is continued for 1 to 2 weeks.
Treatment with antiviral agents such as acyclovir may be beneficial. Acyclovir and prednisone used together are more effective than prednisone alone. The acyclovir-prednisone combination is most effective when begun as soon as possible after the onset of symptoms. One recent study found that patients had a 100% recovery rate when treated within 3 days of symptom onset, compared to an 84% recovery rate when treatment was delayed 4 days or longer.
Physical Therapy and Bell's Palsy
A special form of physical therapy called facial retraining can help minimize the asymmetrical appearance of the face that occurs when one side is weakened. It improves muscle mobility, even when therapy is initiated years after the onset of Bell's palsy. Hemifacial spasm may be relieved with botulinum toxin injections (BOTOX Cosmetic).
Other Therapies for Bell's Palsy
Many patients incorporate alternative health care remedies such as acupuncture, traditional Chinese medicine (TCM), and homeopathy regimens into their treatment. Facial exercises may improve muscle tone and help the facial nerve recover. Exercises for Bell's palsy patients have been developed by physical therapists and other specialists.
Bell's Palsy Prevention
Currently, there is no way to prevent Bell's palsy.