Bell’s palsy is a neurological disorder that causes severe weakness or paralysis on one side of the face. A person may be unable to close one eyelid. Eye care is important during recovery to help prevent dry eye and other complications.
According to the National Institute of Neurological Disorders and Stroke, Bell’s palsy affects around 40,000 people in the United States.
Symptoms typically appear over 48–72 hours. They usually improve within a few weeks. In some cases, a person may experience permanent facial weakness.
This guide explains how Bell’s palsy can affect the eye. It provides information on how and when to use eye drops and how to care for the eye during recovery.
How can Bell’s palsy affect the eye?
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Bell’s palsy affects the facial nerve responsible for closing the eyelids but does not affect the muscle responsible for opening the eyelids. A person with the disorder may therefore be unable to close their eye. The eye can remain constantly open.
Healthy eyelids continuously distribute an even tear film over the eye’s surface. If a person cannot close their eyelid, eye dryness from a lack of tear film lubrication may lead to exposure keratopathy, which is damage to the cornea due to severe dryness.
This may cause eye pain and other symptoms. A dry eye may also increase the risk of infection and other eye damage.
How long will Bell’s palsy affect the eye?
The American Academy of Ophthalmology notes that the symptoms of Bell’s palsy usually begin to improve within 3 weeks and typically resolve within 2–3 months.
Some people may experience lasting symptoms, such as mildly reduced movement or a small area of paralysis.
About 20% of people with Bell’s palsy do not recover nerve function, and their symptoms do not improve or resolve.
Frequent use of artificial tears and ointments is the mainstay treatment to protect eyes affected by Bell’s palsy.
If these steps are inadequate, an eye care specialist called an ophthalmologist may perform tarsorrhaphy. This minor surgical procedure brings the eyelids closer together to reduce exposure.
Implantation of miniature gold or platinum weights beneath the upper eyelid skin can also reduce exposure for people with chronic Bell’s palsy.
Using eye drops for Bell’s palsy
Lubricating eye drops are necessary to prevent or treat eye dryness. Dry eye may lead to infection, severe dryness, and irreversible blindness without treatment.
Signs and symptoms of severe dry eye may include:
- ulcerations
- irritation
- pain
- feeling as if something is in the eye
- burning or stinging sensations
- blurred vision
- watering
- redness
- light sensitivity
- eye mucus
Daytime
To treat or prevent eye dryness, a doctor may prescribe lubricating eye drops, also called artificial tears.
A person may need to use lubricating eye drops at least every 2 hours during the day or as often as their doctor instructs.
To use lubricating eye drops, a person can follow these steps:
- Wash hands thoroughly.
- Remove contact lenses, unless a doctor instructs otherwise.
- Shake the container of eye drops before use.
- Remove the cap of the medication without touching the dropper tip.
- Tilt the head back and look up.
- Gently pull the lower eyelid down and away from the eye to form a pocket.
- Position the dropper over the eyelid pocket. Ensure the dropper does not touch the eye or eyelid.
- Gently squeeze the bottle and let the drop fall into the eyelid pocket.
- Close the eye, but avoid blinking, and apply gentle pressure to the tear ducts where the eyelid meets the nose. Remain like this for about 1–2 minutes.
- Wash hands.
Nighttime
For nighttime, a doctor may prescribe lubricating ointment or gel. These medications are thicker than eye drops. Because of this, they may have a greasy consistency that can blur a person’s vision.
If a doctor recommends a person use lubricating eye drops and ointment or gel, they can use the eye drops first and then wait 3–5 minutes before using the ointment or gel.
To use eye ointment or gel, a person can follow these steps:
- Wash hands thoroughly.
- Uncap the tube of gel or ointment without touching the tip.
- Tilt the head back slightly and pull the bottom eyelid down and away from the eye to form a pocket.
- Gently squeeze a line of ointment or gel into the eyelid pocket. Ensure the tip of the tube does not touch the eye or eyelid.
- Close the eye, but avoid blinking, and look up behind the closed lid to allow the ointment or gel to spread over the eye.
- Wash hands.
How to tape the eye shut at night
If Bell’s palsy causes a person’s eye to remain open, they will need to tape it shut during the night to avoid the eye becoming severely dry. Taping the eye shut can also avoid damage to the eye from dust or other objects.
A person can ask their eye doctor how to tape the eye closed, either with tape alone or with the use of a soft patch.
How to tape the eye closed
To tape the eye closed at night, a person needs clean scissors and soft silicone bandaging tape that has a width of 2.5 centimeters.
To safely and securely tape the eye, a person can follow these steps:
- Wash hands thoroughly.
- Apply eye drops and ointment or gel.
- Cut a length of tape slightly longer than the eye.
- Look down and gently close the eyelid with a finger.
- Holding the eye closed, apply the tape from the inner eye in a horizontal direction until it extends beyond the width of the eyebrow. The tape should cover the entire eye area, from the upper eyelid to the area underneath the eye.
- Press down from the inner eye to the outer eye to ensure there are no air pockets.
- Ensure the tape firmly covers the entire eye area and that there are no gaps or air pockets.
To remove the tape, carefully peel the skin away from the tape, as opposed to the other way around.
Using a soft patch
A doctor may recommend using a soft cloth patch over the eye at night. A person may use sterile cotton eye gauze pads.
To secure the patch in place at night, a person can follow these steps:
- Wash hands thoroughly.
- Apply eye drops and ointment or gel.
- Look down and gently close the eyelid with a finger.
- Place the soft cloth patch over the entire closed eye and hold it in place.
- Place a piece of tape diagonally across the patch, from the forehead above the inner corner of the eye to the cheek beneath the outer eye.
- Ensure the patch is secured in place.
A person should not place the tape directly on the eyelid. The patch should cover the entire eye area, and the tape should meet the skin on the forehead and cheek.
Protecting and cleaning the skin around the eye
A person should gently clean and dry the skin around the eye before they tape it and after they remove the tape.
A person can gently clean the sensitive skin around the eye with a clean, warm, wrung-out compress or cotton pad, and lukewarm, sterile water.
Then, they can gently pat the area dry with a clean towel and ensure nothing touches the eye itself to avoid the spread of bacteria.
How to protect the eye during the day
A person with Bell’s palsy must protect the eye during the day to help prevent damage to the cornea.
Smoke, dust, grit, or other objects may enter the eye, but the eyelid cannot function to blink them away. Objects may scratch, poke, irritate, and damage the eye, which could affect vision or lead to infection.
Exposure to elements such as wind or bright sunshine may also affect the eye. It could lead to further dryness or damage.
A person can protect their eye by wearing glasses, sunglasses, an eye patch, or goggles.
Researchers recommend athletes protect their eyes with athletic goggles during athletic activities.
Showering and bathing
A person can avoid getting water or bath or shower products in their open eye while bathing or showering by wearing goggles or a face shield, or by showering with their back to the water.
They may gently clean around the eye outside of the bath or shower.
Can physical exercises help speed up the recovery of the eye?
A person should speak with a doctor before performing facial exercises for Bell’s palsy. There is no consensus regarding the benefit or value of performing facial exercises.
However, a 2022 targeted review suggests facial exercises may improve facial functioning and be effective in early cases of Bell’s palsy when performed alongside other treatments.
Exercises for Bell’s palsy aim to limit overuse of the side of the face the disorder has not affected. This may help maximize symmetry and help the affected muscles recover.
To help the eye, a person can use one finger to gently lift the eyebrow and gently close the eyelid.
A person can also:
- put one finger into the corner of the mouth on the affected side and gently pull it out and into a smile
- gently stroke the affected side of the face in an upward motion, starting near the corner of the mouth and moving up toward the cheekbone
When to contact a doctor
A person should contact a doctor regarding eye complications of Bell’s palsy if they experience symptoms of severe dryness, damage to the eye, or infection. These symptoms may include:
- pain
- irritation
- blurred vision
- redness
- discharge
- feeling as if something is in the eye
- sensitivity to light
- swelling
Summary
People with Bell’s palsy may be unable to close one eye. This can cause the eye to become severely dry, which can lead to infection and damage.
To counteract eye dryness, a person can use lubricating eye drops during the day and ointment or gel during the night. They can also tape their eye closed during the night, according to a doctor’s instructions.
A person can wear glasses, sunglasses, goggles, or an eye patch to protect their eye during the day. Performing certain facial exercises may help recovery.
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