Bell's palsy: Difference between revisions
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| Line 19: | Line 19: | ||
==Treatment== | ==Treatment== | ||
#Cornea | #Cornea | ||
##Artificial tears qhr while pt is awake | ##Artificial tears qhr while pt is awake AND | ||
##Ophthalmic ointment at night | |||
##Protective glasses or goggles | ##Protective glasses or goggles | ||
#Corticosteroids | #Corticosteroids | ||
##Give to all pts | ##Give to all pts | ||
##Prednisone 60-80mg | ##Prednisone 60-80mg qday x1wk | ||
#Antivirals | #Antivirals | ||
##Controversial efficacy; may have benefit in pts w/ severe palsy | ##Controversial efficacy; may have benefit in pts w/ severe palsy | ||
| Line 29: | Line 30: | ||
==Disposition== | ==Disposition== | ||
*Discharge with | *Discharge with ophtho f/u for monitoring of the affected cornea | ||
==Source== | ==Source== | ||
Tintinalli | *Tintinalli | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 17:01, 18 November 2011
Background
- Dysfunction of peripheral CN VII of unknown cause
- Maximal clinical weakness around 3wks; at least partial recovery by 6 months
- Always test CN VI function (should be normal) to rule-out CVA
DDX
- Lyme Disease
- HIV
- Otitis Media
- Sarcoidosis (esp if b/l)
Clinical Features
- Acute onset (over hours) of unilateral facial paralysis
- No forehead sparing
- Mouth drawn to the non-affected side
- Incomplete closure of the eyelids on the affected side
- Can lead to corneal exposure keratitis
Treatment
- Cornea
- Artificial tears qhr while pt is awake AND
- Ophthalmic ointment at night
- Protective glasses or goggles
- Corticosteroids
- Give to all pts
- Prednisone 60-80mg qday x1wk
- Antivirals
- Controversial efficacy; may have benefit in pts w/ severe palsy
- Valacyclovir 1000mg TID x1wk
Disposition
- Discharge with ophtho f/u for monitoring of the affected cornea
Source
- Tintinalli