Question

45 year-old man presents after he cannot close his left eye. In the photo below, he is trying to simultaneously raise his forehead and smile. Of note, he was also started on doxycycline recently for Lyme disease. What two medications should he receive?

Answer

1. Prednisone
2. Eye drops for lubrication of the affected eye

Bell Palsy

• Etiologies include Lyme disease, Herpes Simplex Virus, Guillain-Barre, Epstein-Barr Virus, etc.
• Critical action is to distinguish Bell palsy from a stroke
  • Bell palsy affects peripheral portion of 7^th cranial nerve (motor and sensory). Inability to wrinkle forehead (shown here), close eyelid, and an asymmetric smile is classic and taste to anterior 2/3 of tongue (sensory) is also affected.
  • Stoke affects the central 7^th cranial nerve causing an asymmetric smile, but the ability to wrinkle the forehead and close eyelid is preserved (due to bilateral cross-over of the peripheral 7^th nerve fibers)
• The two medications that should be given are:
  • Prednisone for 7-14 days
  • Eye drops / ointment to maintain eye moisture and lubrication
• Don’t forget to discharge with instruction to patch their eye during sleep to protect their eye
• About 85% of patients recover within three weeks.

References

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