1.7 Facial Paralysis (Bell’s Palsy)

Paralysis or loss of strength (motor function) of the muscles of facial expression can result in an acute inability of eye closure and blinking. This can cause severe disability and when inadequately managed, can lead to threatening of vision.
Acute management involves close clinical monitoring, an intensive regime of medication (eyedrops and creams) as well as exercises and other protective measures.
The majority of facial nerve paralysis is thankfully temporary and once the appropriate investigations and scans are carried out, then non-invasive management will be employed until the eye muscles regain its strength and function. A self-limiting condition known as Bell’s Palsy is very often the cause of this facial nerve paralysis treatment for which involves steroid (and sometimes antiviral) tablets. Though it is important for this treatment to be instituted as soon as possible by the physician to whom a patient first presents with facial paralysis, it is imperative that a final diagnosis of Bell’s Palsy is not made without an appropriate referral to the hospital specialists. The reason for this is, is so that the less common but more sinister causes of facial paralysis can be ruled out.
These uncommon causes, infections, tumours, trauma, recent surgery or vascular events all require different treatment strategies and can be expected to either be slower to resolve or result in permanent loss of muscle strength.
Cases resulting in permanent weakening or complete paralysis of the muscles around the eye, cheek and eyebrow require complex oculoplastic surgery procedures so that the function and appearance of the area can be optimised. These procedures are geared towards improving the quality of the natural blink and eyelid closure thus protecting the eye, repositioning the eyelid and eyebrow to a more anatomical position, improving ocular dryness or tearing and restoring symmetry. Treatment is always personalised and can sometimes require a staged approach for an optimum result.