Template:Bell's palsy Treatment: Difference between revisions
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===Eye Protection=== | ===Eye Protection=== | ||
*Cornea eye protection ([[EBQ:Evidence Levels|Level X]])<ref name="bells guidelines"></ref> | |||
*Cornea eye protection ([[Special:MyLanguage/EBQ:Evidence Levels|Level X]])<ref name="bells guidelines"></ref> | |||
**Artificial tears qhr while patient is awake | **Artificial tears qhr while patient is awake | ||
**Ophthalmic ointment at night | **Ophthalmic ointment at night | ||
**Eye should be taped shut at night | **Eye should be taped shut at night | ||
**Protective glasses or goggles | **Protective glasses or goggles | ||
===Steroids=== | ===Steroids=== | ||
''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> | ''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> | ||
*[[Prednisone]] 60-80mg qday x1wk<ref name="UpToDate Bells">UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref> ([[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> | *[[Special:MyLanguage/Prednisone|Prednisone]] 60-80mg qday x1wk<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=== | ===Antivirals=== | ||
''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> | ||
*[[Valacyclovir]] 1000mg TID x1 week<ref name="UpToDate Bells"></ref> '''OR''' | *[[Special:MyLanguage/Valacyclovir|Valacyclovir]] 1000mg TID x1 week<ref name="UpToDate Bells"></ref> '''OR''' | ||
*[[Acyclovir]] 400mg 5x per day x1 week | *[[Special:MyLanguage/Acyclovir|Acyclovir]] 400mg 5x per day x1 week | ||
===Antibiotics=== | ===Antibiotics=== | ||
*Consider empiric [[doxycycline]] if high index of suspicion for [[Lyme]] based on clinical presentation or lab data | |||
*Consider empiric [[Special:MyLanguage/doxycycline|doxycycline]] if high index of suspicion for [[Special:MyLanguage/Lyme|Lyme]] based on clinical presentation or lab data | |||
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Revision as of 03:32, 26 January 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[3] OR
- Acyclovir 400mg 5x per day x1 week
Antibiotics
- Consider empiric doxycycline 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
- ↑ 3.0 3.1 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.