Bell’s Palsy is a condition causing sudden weakness or paralysis of facial muscles, usually on one side of the face. This paralysis often affects the ability to blink and fully close the eye on the affected side. Due to this impact on eyelid function, proper eye care is crucial to prevent complications and maintain eye health.
Understanding Eye Vulnerability
The eye becomes vulnerable in Bell’s Palsy because the facial nerve (seventh cranial nerve) controls the orbicularis oculi muscle, which is responsible for eyelid closure and blinking. When this nerve is compromised, the affected eyelid may droop and be unable to close completely. This exposes the eye to the environment, leading to several issues.
Constant air exposure causes the tear film to evaporate rapidly, leading to severe dryness known as exposure keratitis. Without adequate lubrication and blinking, the eye surface, especially the cornea, becomes susceptible to irritation, redness, and discomfort. Prolonged dryness can result in corneal abrasions or ulcers (open sores on the eye’s surface). These complications can cause significant pain, blurred vision, and may lead to permanent vision loss or eye infections.
At-Home Eye Care Strategies
Managing eye dryness and protecting the exposed eye is a primary focus of at-home care for Bell’s Palsy.
Artificial Tears
Artificial tears are a common solution. These drops supplement the natural tear film, providing moisture and reducing irritation. For frequent use, preservative-free artificial tears are recommended to avoid potential irritation.
Eye Ointments
Eye ointments offer longer-lasting lubrication, especially for nighttime use. These thicker formulations create a protective barrier over the eye surface, preventing moisture loss during sleep when the eye may remain open. Ointments can cause temporary blurry vision, but their extended lubricating effect makes them suitable for overnight application.
Taping the Eye Shut
Taping the eye shut at night ensures complete eye closure and protection. To safely tape the eye, clean the skin around it. Gently close the affected eye, ensuring the eyelid is fully descended. Use medical-grade tape, such as 3M Transpore tape or Siltape, and apply a strip horizontally across the closed eyelid, extending it to the skin above and below the eye to secure it. Folding over a small end of the tape can make removal easier.
Moisture Chambers or Goggles
Moisture chambers or goggles create a humid environment around the eye, reducing tear evaporation and maintaining moisture. These devices fit snugly around the eye. They can be worn during the day (clear versions allow vision) or at night for continuous protection.
Environmental Protection
Protecting the eye from environmental irritants is also important. Individuals with Bell’s Palsy should wear glasses or sunglasses during the day to shield the eye from wind, dust, and direct sunlight. Avoiding direct drafts from fans or air conditioning units can also help reduce eye dryness.
Medical and Surgical Interventions
When at-home strategies are insufficient, healthcare professionals may recommend medical or surgical interventions.
Prescription Eye Drops
Prescription eye drops may be prescribed for severe dry eye cases that do not respond to over-the-counter options, or if an eye infection develops. These drops include stronger lubricants or medications to address specific conditions.
Temporary Tarsorrhaphy
Temporary tarsorrhaphy is a minor surgical procedure where the eyelids are partially stitched together. This narrows the eye opening, providing a physical barrier to protect the cornea from exposure and dryness. It is considered for temporary facial paralysis, like Bell’s Palsy, as sutures can be removed once eyelid function improves, typically after weeks or months.
Gold Weight Implant
For prolonged or permanent Bell’s Palsy, a gold weight implant may be considered. In this procedure, a gold or platinum weight is implanted into the upper eyelid. The added weight helps the eyelid close by gravity, allowing for a more complete and natural blink. This procedure restores eyelid closure without affecting the ability to open the eye.
Other Surgical Procedures
Other surgical procedures may improve eye protection and function. These include eyelid tightening procedures, such as a lateral tarsal strip procedure, to address lower eyelid laxity or ectropion (outward turning of the eyelid). These interventions improve eyelid positioning and support, contributing to better eye health and protection.