My sister woke up yesterday and the left side of her face is droopy and the eyelid is closing down. She saw a doctor who says she has Bell’s palsy. What is that?

The 7th cranial nerve has many branches with some controlling the muscles of the face, neck, eyelids, the tear glands, and the salivary glands. We have two, one for each side of the face. Bell’s palsy occurs when this facial nerve is damaged or traumatized. When this happens, it causes a facial paralysis on the affected side. The amount of damage/trauma determines the time until recovery. If the trauma was mild, recovery may take just a few weeks. In most cases, it usually resolves within three to four months, although in some people, improvement is noted even later. It usually occurs on one side of the face (very rarely both sides) and is not permanent. The amount of trauma determines the number of symptoms patients will experience. These can include droopy eyelid, watery eyes, droopy side of the mouth, dry mouth/loss of taste, and paralysis or weakening of the face. A lot of people initially think they have had a stroke and get worried, but this is not the case.

What causes it? Is there any treatment?

We are not sure what causes it, but some scientists believe it occurs in response to infections like meningitis, tuberculosis, rubella, herpes simplex. Of course, it may be a result of injury, accident or trauma. Diabetics are four times more likely to develop Bell’s palsy than non-diabetics. There is currently no cure or treatment for Bell’s palsy. Sometimes, corticosteroid or antiviral medications, given within a few hours of onset, may reduce swelling and pressure on the facial nerve. Moist heat and massage can help the facial muscles. Most patients have problems with the eyelids. They may not close completely when sleeping and this can lead to complications from the eye drying out in that exposed section. If severe, this can lead to corneal ulcers and loss of vision. Some patients may be advised to use lubricating ointments and if severe, some may be patched while asleep. In some patients, the eyelid is stuck in an open position, and the blink pattern will be affected. These patients can experience dry eyes, blurry vision, and discomfort. For these, tear supplements are required.

Will she recover completely? Are there any complications?

Most patients recover completely, however some may have complications of varying degrees. The most common is loss of taste. In around 6% of patients an unusual condition called ‘crocodile tears’ occurs where they start tearing while eating. This may be due to abnormal regeneration of the branch of the facial nerve responsible for the tear and salivary glands. Some patients are left with eyelids that don’t close properly, and these patients can be fitted with either temporary (stick on) or permanent (sutured into) weights on the affected eyelid. Some are left with mild facial paralysis that can benefit from a special type of physical therapy called ‘facial retraining.’