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Facial Paralysis, Bell’s Palsy, or Eyelid Paralysis

Facial or eyelid paralysis and Bell’s palsy can be alarming conditions. If you have experienced facial paralysis and would like a diagnosis, Dr. Sean Paul can help. He is a master ophthalmologist with experience in this area, he can determine your condition and how to best treat it. 

About Bell’s palsy and treatment

Bell’s palsy is named for Sir Charles Bell, a 19th century Scottish surgeon who described the facial nerve and its connection to the condition. The disorder, which is not related to stroke, is the most common cause of facial paralysis. Generally, Bell’s palsy affects only one of the paired facial nerves and one side of the face; however, in rare cases, it can affect both sides. As an expert ophthalmologist, Dr. Paul has the ability to diagnose and treat facial paralysis patients, and determine what their ideal treatment is.

What is Bell’s palsy?

Bell’s palsy is the paralysis or severe weakness of the nerve that controls the facial muscles on the side of the face, the facial nerve (or seventh cranial nerve). Patients typically find they suddenly cannot control their facial muscles, usually on one side. When Bell’s palsy occurs, the function of the facial nerve is disrupted, causing an interruption in the messages the brain sends to the facial muscles. This interruption results in facial weakness or paralysis. The facial nerve travels through a narrow, bony canal called the Fallopian canal in the skull, beneath the ear, to the muscles on each side of the face.

For most of its journey, the nerve is encased in this bony shell. Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. Additionally, the facial nerve carries nerve impulses to the lacrimal or tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the stapes. The facial nerve also transmits taste sensations from the tongue. 

Who gets Bell’s palsy?

Approximately 40,000 Americans develop Bell’s palsy each year. The National Health Service in the UK reports that about 25 to 35 people out of every 100,000 develop Bell’s palsy each year. It is classed as a relatively rare condition, and more commonly affects those over 15 and under 60 years of age. The condition affects men and women equally, and disproportionately attacks people who have diabetes or upper respiratory ailments such as the flu or a cold. A person might have Bell’s Palsy first thing in the morning. They wake up and find that one side of their face cannot move. If an eyelid is affected, blinking might be difficult. Bell’s Palsy usually starts suddenly.

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Confusing Bell’s and cerebral palsy

Bell’s palsy should not be confused with cerebral palsy, which is a completely different condition. Associations have been found between migraines and facial/limb weakness. This has led to a 2015 study which found that people who suffer from migraines may be at much higher risk of Bell’s palsy. Most people who suddenly experience symptoms think they are having a stroke. However, if the weakness or paralysis only affects the face, it is more likely to be Bell’s palsy.

What are the symptoms?

Because the facial nerve has so many functions and is so complex, damage to it or a disruption in its function can lead to many problems. Symptoms from Bell’s palsy can vary from person to person, and range in severity from mild weakness to total paralysis. Most often these symptoms, which usually begin suddenly and reach their peak within 48 hours, lead to significant facial distortion. Our Bell’s palsy patients in Austin may experience:

  • Sudden paralysis or weakness on one side of the face
  • Drooping of the eyelid and corner of the mouth
  • Difficulty closing one eyelid
  • Facial twitching on one side
  • Irritation due to dryness in the eye
  • Changes in the amount of tear production
  • Headache and/or dizziness
  • Parts of face may droop, such as one side of the mouth
  • Drooling from one side of the mouth
  • Difficulty with facial expressions
  • Altered sense of taste
  • Hypersensitivity to sound in one ear
  • Pain in front or behind the ear on the affected side
  • Ringing in one or both ears
  • Impaired speech
  • Difficulty eating or drinking

What causes Bell’s palsy?

Exactly what causes Bell’s palsy is unknown. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus (herpes simplex) causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the fallopian canal and leading to ischemia (the restriction of blood and oxygen to the nerve cells).

In some mild cases where recovery is rapid, there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering which acts as an insulator on nerve fibers in the brain. The disorder has also been associated with influenza or a flu-like illness, headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma such as skull fracture or facial injury.

How is it diagnosed?

There is no specific laboratory test to confirm diagnosis of Bell’s palsy; however, a diagnosis can be made based on clinical presentation. For example, a distorted facial appearance and the inability to move muscles on the affected side of the face and ruling out other possible causes of facial paralysis. Dr. Paul will carefully examine the patient for upper and lower facial weakness. In most cases, this weakness is limited to one side of the face or occasionally isolated to the forehead, eyelid, or mouth. With this thorough evaluation, Dr. Paul will also look for evidence of other conditions which may be causing the facial paralysis, such as a tumor, Lyme disease, or stroke. This will involve checking the patient’s head, neck, and ears. He will also check the facial muscles carefully and determine whether any other nerves are affected apart from the facial nerve. If there is a change in facial structure, it could be evidence of a tumor. A characteristic rash may be evidence of tick bites in Lyme disease.

If all other causes can be excluded, Dr. Paul may diagnose Bell’s palsy. If he is still unsure, the patient may be referred to an ENT (ear, nose and throat) specialist, an otolaryngologist. The referred specialist will then examine the patient and may also order the following tests:

  • Electromyography (EMG): This test can determine the extent of nerve damage, as well as its location. Electrodes are placed on the patient’s face. A machine measures the electrical activity of the nerves and the electrical activity of a muscles in response to stimulation. 
  • MRI, CT scans, or X-rays: These can determine whether other underlying conditions are causing the symptoms, such as a bacterial infection, skull fracture, or a tumor.

What is the prognosis?

The prognosis for individuals with Bell’s palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual, and recovery times vary. With or without treatment, most individuals begin to get better within two weeks after the initial onset of symptoms and most recover completely, returning to normal function within three to six months. For some, however, the symptoms may last longer. In a few cases, the symptoms may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.

How is Bell’s palsy treated?

Bell’s palsy affects each individual differently. Some cases are mild and do not require treatment, as the symptoms usually subside on their own within two weeks. For others, treatment may include medications and other therapeutic options. If an obvious source is found to cause Bell’s palsy (such as infection), directed treatment can be beneficial.

Recent studies have shown that steroids such as prednisone, used to reduce inflammation and swelling, are effective in treating Bell’s palsy. Other drugs such as acyclovir, used to fight viral herpes infections, may also have some benefit in shortening the course of the disease. Analgesics such as aspirin, acetaminophen, or ibuprofen may relieve pain. Because of possible drug interactions, individuals taking prescription medicines should always talk to their doctors before taking any over-the-counter drugs.

Another important factor in treatment is eye protection. Bell’s palsy can interrupt the eyelid’s natural blinking ability, leaving the eye exposed to irritation and over-drying. Therefore, keeping the eye moist and protecting the eye from debris and injury, especially at night, is important. Lubricating eye drops such as artificial tears, eye patches, and eye ointments and gels are also effective. Other therapies such as physical therapy, facial massage, or acupuncture may provide a potential small improvement in facial nerve function and pain.

In general, decompression surgery for Bell’s palsy to relieve pressure on the nerve is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct some damage, such as an eyelid that will not fully close or a crooked smile.

Schedule a consultation with us

If you feel that this information applies to you or someone you love, we’re here to help. Please schedule a consultation with Dr. Sean Paul at Austin Face & Body. As an expert ophthalmologist, Dr. Paul has the ability to diagnose and treat facial paralysis patients. For any questions you may have, or to schedule a consultation, please call 512-642-5050 or contact us online

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