Template:Bell's palsy Treatment: Difference between revisions
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===Eye Protection=== | |||
===Eye Protection=== <!--T:1--> | <!--T:1--> | ||
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**Protective glasses or goggles | **Protective glasses or goggles | ||
===Steroids=== | |||
===Steroids=== <!--T:3--> | <!--T:3--> | ||
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''Should be started within 72hrs of symptom onset''<ref>Vargish L. For | ''Should be started within 72hrs of symptom onset''<ref>Vargish L. For Bell's palsy, start steroids early; no need for an antiviral. J Fam Pract. Jan 2008; 57(1): 22–25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183838/pdf/JFP-57-22.pdf</ref> | ||
* | *{{AntibioticDose|disease=Bell's palsy|drug=Prednisone|dose=60-80mg qday x1wk|context=Steroids}}<ref name="UpToDate Bells">UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref> ([[Special:MyLanguage/EBQ:Evidence Levels|Level B Evidence]])<ref name="Gronseth">Gronseth GS, Paduga R. Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012[http://www.neurology.org/content/79/22/2209.long Full Text]</ref> | ||
===Antivirals=== <!--T:5--> | ===Antivirals=== | ||
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''Most likely no added benefit when combined with steroids.''<ref>Lockhart et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869.</ref> However also little harm associated with antivirals especially in patients with normal renal function<ref name="Gronseth"></ref> | ''Most likely no added benefit when combined with steroids.''<ref>Lockhart et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869.</ref> However also little harm associated with antivirals especially in patients with normal renal function<ref name="Gronseth"></ref> | ||
* | *{{AntibioticDose|disease=Bell's palsy|drug=Valacyclovir|dose=1000mg TID x1 week|context=Antiviral}} '''OR''' | ||
* | *{{AntibioticDose|disease=Bell's palsy|drug=Acyclovir|dose=400mg 5x per day x1 week|context=Antiviral}} | ||
===Antibiotics=== <!--T:7--> | ===Antibiotics=== | ||
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*Consider empiric | *Consider empiric {{AntibioticDose|disease=Bell's palsy|drug=Doxycycline|dose=empiric dosing|context=Lyme Suspicion|link=no}} if high index of suspicion for [[Special:MyLanguage/Lyme|Lyme]] based on clinical presentation or lab data | ||
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Revision as of 00:56, 20 March 2026
Eye Protection
- Cornea eye protection (Level X)[1]
- Artificial tears qhr while patient is awake
- Ophthalmic ointment at night
- Eye should be taped shut at night
- Protective glasses or goggles
Steroids
Should be started within 72hrs of symptom onset[2]
- Prednisone 60-80mg qday x1wk[3] (Level B Evidence)[4]
Antivirals
Most likely no added benefit when combined with steroids.[5] However also little harm associated with antivirals especially in patients with normal renal function[4]
- Valacyclovir 1000mg TID x1 week OR
- Acyclovir 400mg 5x per day x1 week
Antibiotics
- Consider empiric empiric dosing if high index of suspicion for Lyme based on clinical presentation or lab data
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedbells guidelines - ↑ Vargish L. For Bell's palsy, start steroids early; no need for an antiviral. J Fam Pract. Jan 2008; 57(1): 22–25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183838/pdf/JFP-57-22.pdf
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ 4.0 4.1 Gronseth GS, Paduga R. Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012Full Text
- ↑ Lockhart et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869.