Bell's Palsy and Your Eye

Bell's palsy is a sudden weakness or droop of one side of the face. It happens when the facial nerve, which moves the muscles of the face, becomes swollen and stops working properly [1]. The cause is not fully known, but it may be linked to a virus.

It usually comes on over a few hours to 2 days. It is not a stroke, and it is not contagious.

Why does it matter for the eye?

The same nerve closes your eyelid. If the eyelid cannot close and you blink less, the front of the eye (the cornea) dries out. This can cause dry eye, and in some people a sore, damaged cornea called exposure keratopathy. Without protection, this can lead to an ulcer and lasting damage to sight [1][2].

On one side of the face, you may notice [1]:

• a drooping mouth or eyebrow, or difficulty smiling
• the forehead cannot wrinkle
• the eye does not close fully, or it waters or feels dry and gritty
• drooling, or food getting stuck in the cheek
• pain behind the ear, changes in taste, or sounds seeming louder

It is more common in pregnancy, and in people with diabetes or after a cold or flu [1][2].

A stroke can also cause a drooping face, so a doctor must check you straight away. Think FAST [4]:

• Face: has one side drooped?
• Arms: can they raise both arms and keep them up?
• Speech: is it slurred or muddled?
• Time: call 991 at once if you see any of these.

In Bell's palsy the whole side of the face, including the forehead, is weak. If the person can still wrinkle their forehead on the weak side, this points more to a stroke [2].

For the face [1][2][3]:

• Steroid tablets (prednisolone) help the nerve recover. They work best when started within 72 hours (3 days) of the weakness starting, so see a doctor early.
• Antiviral tablets are sometimes added in severe cases.

For the eye (this is very important) [1][2]:

• By day: use lubricating eye drops (artificial tears) often, every hour or two if needed.
• At night: put eye ointment in, then tape the eyelid closed with medical tape. Your doctor or nurse can show you how. Make sure the tape does not touch the eye.
• Outdoors: wear sunglasses or wrap-around glasses to protect from wind and dust.
• Gently close the eyelid with a clean finger a few times a day.

Will it get better?

Most people recover fully. Improvement usually starts within a few weeks, and full recovery can take a few months [1][3]. If the eye still cannot close after some time, an eye specialist can offer other treatment, such as a small weight in the upper eyelid.

• Keep using your drops, ointment and taping until the eye closes fully again.
• Do not rub the eye. Avoid fans and air-conditioning blowing at your face.
• Do not wear contact lenses on the affected side until your doctor says it is safe.
• Go to your follow-up appointments so your face and eye can be checked.

Where to get help in Brunei

If your eye is dry, sore or red, you can walk in to any Community Eye Clinic at your health centre. No referral is needed.

For a sudden drooping face, go to the hospital Emergency Department first, to rule out a stroke. Call 991 if there is also arm or leg weakness or slurred speech.