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Bell palsy - External and Internal Eye
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Bell palsy - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Andrea Wasilewski MD, Richard L. Barbano MD, PhD
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Synopsis

Bell's palsy is the most common type of facial neuropathy, with an average yearly incidence (in the United States and internationally) of about 0.02%. Men and women are affected equally, although pregnant women have a slightly higher risk, as do individuals with diabetes. Bell's palsy can occur in children, but the condition more commonly affects adolescents and adults. Bell's palsy is a diagnosis of exclusion. Patients typically present with acute onset of unilateral facial paralysis, but it may sometimes be bilateral. It may or may not be associated with pain or facial numbness.

Although the etiology for Bell's palsy is idiopathic, autoimmune and/or viral-induced inflammation of the peripheral nerve is believed to play a role. Herpes zoster sometimes causes Bell's palsy and is associated with vesicles by the ear (Ramsay-Hunt syndrome). Herpes simplex, cytomegalovirus, Epstein-Barr virus, and Borrelia infections including Lyme disease have also been associated. The use of some medications has rarely been associated with Bell's palsy.

Patients may complain of difficulty with their speech and eating because of mouth droop. Due to the paralytic eyelid muscles, patients may have incomplete eye closure, causing their eyes to feel dry and leading to excessive corneal exposure and sometimes ulceration. Patients may have difficulty blinking, altered taste and tear production, and hyperacusis. The palsy is usually sudden in onset, with maximal facial weakness developing within 2 days. Facial or retroauricular pain may also be associated, but severe pain is highly suggestive of herpes zoster infection.

Eighty-four percent of patients with Bell's palsy have spontaneous recovery within 2-3 months. Although most patients recover, up to 30% have residual pain and facial asymmetry. Aberrant regeneration (synkinesis) may occur after an acute episode.

Codes

ICD10CM:
G51.0 – Bell's palsy

SNOMEDCT:
193093009 – Bell Palsy

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

During its prodromal phase, Ramsay-Hunt syndrome may present as Bell's palsy with otalgia.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 03/13/2018
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Bell palsy - External and Internal Eye
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Bell palsy : Unilateral, Otalgia, Excessive tearing, Altered taste, Dry eyes, Facial droop
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