Mx of Bell’s palsy in primary care?

Management of Bell’s palsy in primary care involves prompt diagnosis, exclusion of alternative causes, and initiation of treatment to improve outcomes and reduce complications. Bell’s palsy typically presents as sudden onset unilateral facial paralysis without other neurological deficits, and primary care clinicians should first exclude serious neurological conditions or alternative diagnoses such as stroke or Ramsay Hunt syndrome ¹ (RF et al., 2013).

Once Bell’s palsy is diagnosed, the mainstay of treatment is a short course of oral corticosteroids, ideally started within 72 hours of symptom onset, to reduce nerve inflammation and improve recovery rates ¹ (RF et al., 2013). Prednisolone is commonly prescribed at a dose of 50 mg daily for 10 days with a tapering regimen. Antiviral therapy (e.g., aciclovir) is not routinely recommended unless there is clinical suspicion of herpes zoster involvement, as evidence for benefit is limited ¹ (JA et al., 2018).

Supportive care includes eye protection measures such as lubricating eye drops and eye patching to prevent corneal damage due to incomplete eyelid closure ¹ (SW et al., 2023). Patients should be advised on facial physiotherapy, although evidence for its effectiveness is variable, it may help maintain muscle tone and prevent contractures.

Referral to secondary care is indicated if the diagnosis is uncertain, if there are atypical features (e.g., gradual onset, additional neurological signs), or if there is no improvement after 3 months ¹ (RF et al., 2013). Urgent referral is warranted if stroke or other serious neurological conditions are suspected. Follow-up in primary care should monitor recovery and manage complications such as synkinesis or persistent weakness ¹ (SW et al., 2023).

In summary, primary care management of Bell’s palsy focuses on early corticosteroid treatment, eye care, patient education, and appropriate referral when indicated, integrating guideline recommendations with evidence from recent clinical studies ¹ (RF et al., 2013; JA et al., 2018; SW et al., 2023).