Bell's Palsy Treatment

Author: Michelle Lin, MD
Updated: 2/21/2013

Bell's Palsy Treatment


  • Corticosteroids, if onset within 72 hours
  • 1 in 11 were helped (to complete recovery) -
  • Prednisone: 60 mg daily x 1 week. May consider taper for days #8-10
  • Artificial tears in daytime and lubricating eye ointment at night to prevent corneal drying and exposure
  • Tape eyelid shut while asleep.

Controversial benefit of antivirals (at most risk difference of 7%):

  • American Academy of Neurology (2012), JAMA (2009), and UpToDate suggest giving for severe cases such as for Grade IV and higher
  • Cochrane review (2009): No antivirals indicated.
  • Valacylovir 1000 mg TID or Acyclovir 400 mg 5x daily x 1 week
  • Also prescribe corticosteroids, if antivirals given.

House-Brackmann grading for severity of facial nerve weakness

Grade I

  • Dysfunction: none
  • Gross weakness: no weakness
  • At rest: no weakness
  • Motion: normal function all groups

Grade II

  • Dysfunction: mild
  • Gross weakness: slight weakness noticeable on close inspection. May have very slight synkinesis
  • At rest: normal symmetry and tone
  • Motion: forehead - moderate to good function; mouth - slight asymmetry

Grade III

  • Dysfunction: moderate
  • Gross weakness: obvious but not disfiguring difference; noticeable but not severe synkinesis, contracture, and/or hemifacial spasm
  • At rest: normal symmetry and tone
  • Motion: forehead - slight to moderate movement; mouth - slightly weak with maximum effort

Grade IV

  • Dysfunction: moderately severe
  • Gross weakness: obvious weakness and/or disfiguring asymmetry
  • At rest: normal symmetry and tone
  • Motion: forehead - none; mouth - asymmetric with maximum effort

Grade V

  • Dysfunction: severe
  • Gross weakness: only barely perceptible motion
  • At rest: asymmetry
  • Motion: forehead - none; mouth - slight movement

Grade VI

  • Dysfunction: total paralysis
  • Gross weakness: no movement
  • At rest: asymmetry
  • Motion: none for all groups


  • Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012 Nov 27;79(22):2209-13. doi: 10.1212/WNL.0b013e318275978c. Epub 2012 Nov 7. [PubMed]
  • de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, Chen JM. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009 Sep 2;302(9):985-93. doi: 10.1001/jama.2009.1243. [PubMed]
  • Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869. doi: 10.1002/14651858.CD001869.pub4. [PubMed]