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Bell’s Palsy
What is it?
This pathologic condition causes paralysis of muscles
innervated by the 7th cranial nerve (facial), which
moves structures surrounding the brows, eyelids, and
mouth. The eyelid on the affected side does not close
properly; so corneal drying may become a problem.
There is difficulty in smiling, forehead wrinkling, and
lid closure which may require suturing together for
the course of the disease or lubrication being applied
topically.
What Causes it?
Bell's palsy is most often connected with a viral
infection such as herpes (the virus that causes cold
sores), Epstein-Barr (the virus that causes
Mononucleosis), or influenza (flu) It's also
associated with the infectious agent that causes
Lyme disease. Of course, this doesn't mean that
everyone who has a viral infection or (Lyme
disease) will develop Bell's palsy. Most people
don't. But in a few people, the immune system's
response to a viral infection leads to inflammation
of the nerve. Because it's swollen, the nerve gets
compressed as it passes through a small hole at the
base of the skull, which causes the symptoms of
Bell's palsy.
What is affected?
Sounds seem excessively loud and a person may
experience “crocodile tears” in which the patient
tears on eating instead of salivating. This results
from misguided growth of the regenerating
salivary and lacrimal axons. For many, although
the lacrimal gland produces tears, without a blink
the tears cannot coat the eye. The eye may appear
to be tearing excessively. It actually only seems
that way because the tears are not being spread
over eye, but instead are collecting in the limp
lower lid or running out of the eye. This can
develop during recovery.
Exams and Tests
-Blood tests for sarcoidosis or Lyme Disease
-Magnetic resonance imaging (MRI)
-Electomyography (EMG)
Symptoms
Symptoms usually start suddenly and range
from mild to severe. They include:
*Change in facial expression
*Drooling due to lack of facial muscle
control
*Droopy eyelid or corner of mouth
*Dry eye or mouth
*Face feels stiff or pulled to one side
*Sensitivity to sound
*Difficulty closing one eye
Treatment
There is no treatment of most cases but there
are treatments to relieve symptoms. For the
symptoms of Bell's palsy to improve, the nerve
needs to renew itself, and that can only happen
with time. However, some doctors may
prescribe medicine to reduce inflammation. If
a person with Bell's palsy is unable to close
one eye completely, the doctor may prescribe
eye drops, an eye patch, and protective glasses
to make a person feel more comfortable and to
prevent damage to the cornea.
A moisture chamber will
provide the same or better protection than a
patch, but is clear to allow better vision. One
type is very much like goggles designed for
just one eye, and it works well. If it becomes
foggy due to the tight seal, a tiny pinhole will
solve the problem. For nighttime protection if
the eye will not close, lubricants (gels &
ointments), or lubricants combined with a
patch are a good solution. Gels are thicker than
artificial tears due to the addition of mineral
oil. The consistency is very much like
Vaseline. By adding a "pirate's patch,”not only
will the eye be protected from debris and
injury, but also light will be kept out, and the
patient may find it easier to fall asleep. Skin
Tone External Eyelid Weights are the newest
development, and work quite well. The weight
on the eyelid works with gravity to assist
blinking. It's worn on the upper eyelid, just
above the eyelashes, and is attached daily with a
double-sided adhesive strip. They're available
only with a prescription. Potential downsides
are irritation caused by the adhesive, and
problems with the adhesive lasting long enough
during long days.
Prevention.
There is no prevention.
References
Cassin, B., & Rubin, M. L. (2006). B.
Dictionary of Eye Terminology 5th
edition (5th ed., pp. 45-46).
Gainesville, FL: Triad Publishing
Company (Fl).
MD, S. G. (2008). Neuroophthalmology.
Ophthalmology Made Ridiculously
Simple (Medmaster Ridiculously
Simple) (4 ed., pp. 46-47). Miami:
Medmaster.
Opoliner., J., & Diels, J. (n.d.). Bells Palsy
Information Site. Eye Care. Retrieved
July 5, 2010, from
www.bellspalsy.ws/eyecare.htm
Scavina, M. (n.d.). Teens Health-Bell's Palsy.
kidshealth.org. Retrieved July 6, 2010,
from kidshealth.org/Kids' Health
Problems - Cached – Similar.
Jasmin, L. (n.d.). Bell's palsy: MedlinePlus
Medical Encyclopedia. National
Library of Medicine - National
Institutes of Health. Retrieved July 1,
2010, from
http://nlm.nih.gov/medlineplus/ency/ar
ticle/000773.htm
Created by Connie Pester