- Eye care (lubricants + night-time taping)
- If seen in 1st 72 hrs, 50 mg Prednisolone daily for 10 days
- If Ramsay-Hunt syndrome (look for painful vesicles around ear, mouth, or scalp) also antivirals.
Note that rates of complete resolution without steroids are 72%, but with steroids (within 72 hrs) are 83%, so NNT about 10.
Indications for referral
In early phase: concerns about either 1. eye or 2. accuracy of diagnosis.
Eye: ophthalmology review if corneal irritation or ulceration or if persistent dry eye.
Accuracy of diagnosis: Refer to ENT or to neurology, whichever seems more appropriate, if any of the following features of concern are present:
- Other neurological findings besides the facial palsy
- Bilateral facial palsy
- Onset over >3 days
- Palpable pre-auricular mass
- Systemic constitutional symptoms
Later: Refer if no improvement by 3 weeks or incomplete resolution after 3 months. However, the pathway is different: in both cases referral should be in order to exclude an alternative aetiology, but in the second case there’s another reason, which is to look at whether early surgical or non-surgical interventions might improve the short-term or long-term outcome. Therefore, if no improvement by 3/52 then the referral should be to a facial palsy service run by ENT, but if incomplete resolution by 3/12 it should be to facial palsy services run by plastic surgery.