Bell's palsy treatment

1. Start oral corticosteroids early
   • Best if begun within 72 hours of onset.
   • A common adult regimen is prednisone/prednisolone 50-60 mg daily for 5 days, then taper over 5 days. Exact regimen should be prescribed by a clinician.
   • Steroids improve the chance of complete recovery. AAFP evidence review
2. Protect the affected eye If the eyelid does not close fully:
   • Artificial tears frequently during the day
   • Lubricating eye ointment at night
   • Tape the eyelid closed or use an eye patch at night
   • Urgent eye assessment if there is eye pain, redness, reduced vision, or a feeling of grit. Corneal protection is essential in severe palsy. Goldman-Cecil Medicine, p. 2973
3. Consider an antiviral only with steroids
   • For severe weakness, some clinicians add valacyclovir or acyclovir.
   • Antivirals must not be used alone because they do not improve outcomes on their own.
   • Added benefit is small and is mainly considered to reduce later synkinesis, especially in severe cases. NICE guidance
4. Physiotherapy
   • Facial exercise therapy may help in severe paralysis or if weakness persists beyond about 3 months.
   • Routine electrical stimulation is not usually standard first-line care; evidence remains uncertain.
5. Follow-up and referral
   • Review if there is no improvement by 3 weeks, incomplete recovery by 3 months, or worsening symptoms.
   • Refer urgently to ENT/neurology or ophthalmology when appropriate.

Seek emergency care now if