What are the potential complications of Bell's Palsy that I should monitor for in my patients?

Potential complications of Bell's Palsy to monitor for include:

• Eye complications due to inability to close the eye, such as corneal abrasion, irritation, pain, itching, and vision changes. Patients unable to close their eye at bedtime should tape it closed with microporous tape and avoid eye patches, swimming, and dusty environments. They should use lubricating eye drops during the day and ointment at night to keep the eye moist. Immediate medical advice should be sought if ocular symptoms develop ¹.
• Persistent facial paralysis beyond 3 months, which may indicate incomplete recovery and require specialist referral ¹.
• Development of aberrant reinnervation symptoms such as gustatory sweating or jaw-winking occurring 5 months or more after onset, warranting neurological assessment ¹.
• Emotional and psychological consequences from persistent facial paralysis or paresis, which may require support or counselling ¹,³.
• Signs suggesting alternative diagnoses or complications such as upper motor neuron involvement, cancer, trauma, or severe infection, which require urgent referral ¹,².
• Late sequelae including synkinesis (involuntary facial movements) which may be reduced by combined corticosteroid and antiviral treatment but still require monitoring ¹.