Bell's palsy is a dysfunction of peripheral cranial nerve (CN) VII commonly of viral origin. The orbicularis muscles are involved, frequently resulting in incomplete closure of the eyelids on the affected side. If the eye rolls up under the upper lid on attempted blinking ( Bell's phenomenon), the cornea will be moistened and the risk of corneal exposure keratitis and subsequent ulceration will be less. These patients should still use viscous topical wetting agents, such as Celluvisc or Lacrilube, to keep the corneal epithelium from breaking down. Ophthalmology referral for outpatient monitoring of the cornea is warranted. The patient's medical doctor or neurologist should follow the patient for the dysfunction of CN VII and be involved in the decision to institute or forego oral steroid treatment, since this remains an area of controversy.
1. Test ipsilateral abduction [rule out genu VII Bell's palsy *]
2. Have patient use eye lubricants every 2 h (Celluvisc or artificial tears) and ointment at bedtime.
3. Consider oral steroids
4. Refer to ophthalmology for outpatient monitoring of cornea.
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