Treatment

Provide symptom-based treatment for all patients (regardless of the cause).

• Incomplete eye closure: Initiate eye care (e.g., artificial tears, eye ointment, and/or taping or patching of the eye). [9]

• Incomplete mouth closure: Advise the patient on proper lip and mouth care.

Idiopathic peripheral facial nerve palsy is self-limited, but early treatment is recommended to improve recovery time and prevent incomplete recovery.

• Oral glucocorticoids: Consider for all patients (regardless of severity).

  • Start early (i.e., within 48–72 hours of symptom onset)

  • Available agents: prednisone OR prednisolone

• Antivirals

  • Consider adding an antiviral to steroid therapy (do not use as monotherapy). [8][9]

  • Available agents: acyclovir OR valacyclovir

Initiate therapy (i.e., oral glucocorticoids with or without antivirals) within 48–72 hours of symptom onset.

Consider the following depending on the suspected etiology.

• Peripheral causes

  • Antiviral therapy for herpes zoster (see “Treatment” in “Shingles”) [13]

  • Antibiotic therapy for Lyme disease or otitis media (see “Treatment” in “Lyme disease” and “Otitis media”) [14]

• Central causes: See “Treatment” sections in “Ischemic stroke,” “Intracerebral hemorrhage,” “Multiple sclerosis,” and “Brain tumors.”

• Idiopathic facial palsy: complete recovery in ∼ 85% of cases (within 3 weeks)

• Misdirected regrowth of nerve fibers can lead to persistent disorders (e.g., synkinesias)