Bell's Palsy: Sudden Facial Weakness — Causes, Treatment, and Recovery

You wake up in the morning and one side of your face will not move. You cannot close your eye properly, your smile is lopsided, and your face feels tight or weak. This is a terrifying experience — but in most cases, it is Bell's palsy, not a stroke, and it recovers very well with early treatment.

What Is Bell's Palsy?

Bell's palsy is sudden weakness or paralysis of one side of the face, caused by inflammation and swelling of the facial nerve. It is typically caused by a viral infection — most commonly reactivation of the herpes simplex virus (the cold sore virus). It can occur at any age, in both sexes. It can occur during pregnancy and is more common in people with diabetes.

Bell's Palsy vs Stroke: How to Tell the Difference

This is the most important first step — ruling out a stroke. The key difference:

• In Bell's palsy: Both the upper and lower face are affected on the same side. The patient cannot close the eye or raise the eyebrow on the affected side.
• In stroke: Usually only the lower face is affected (the forehead and eye are spared), because the upper facial muscles have dual brain supply. A stroke also usually comes with other symptoms — arm weakness, speech changes, walking difficulty.

If there is any doubt, get to a neurologist or emergency department immediately. A stroke requires different and urgent treatment.

Symptoms of Bell's Palsy

• Sudden onset (often overnight) of weakness or complete paralysis of one side of the face
• Inability to close the eye on the affected side
• Drooping of the corner of the mouth
• Difficulty eating and drinking (food collects in the affected cheek)
• Drooling from the affected side
• Pain behind the ear (often precedes the weakness by a day)
• Altered taste, or increased sensitivity to sound on the affected side

Treatment — Start Immediately

Treatment works best when started within 72 hours of onset:

• Corticosteroids (prednisolone): Reduce nerve inflammation and significantly improve recovery. The standard treatment for Bell's palsy.
• Antiviral medication: Often added alongside steroids (acyclovir or valacyclovir)
• Eye care: This is critical — an eye that cannot close will dry out and get damaged. Artificial tear drops during the day and eye tape or a moisture chamber at night are essential until eye closure returns
• Physiotherapy: Facial exercises to prevent contracture and aid recovery

Recovery

With early treatment, approximately 70–85% of patients recover fully within 3–6 months. Even without treatment, many cases recover — but treatment improves the speed and completeness of recovery, particularly in complete paralysis.

"Every day matters with Bell's palsy — starting steroids within 72 hours of onset dramatically improves outcomes. Do not wait."

Dr. Anand Karnam provides urgent neurology consultations including Bell's palsy assessment at Sri Anand Child and Neuro Center, Chanda Nagar. Call +91 90633 66983.