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Aetiology
Incidence
Examination
Differentiate between upper and lower motor neurone lesion UML: frontalis is spared allowing normal furrowing of brow and eye blinking LML: all muscles of facial expression are affected
Examination continued
Check no other cranial nerves involved (BP is an isolated VII lesion) Look for a painful rash over the ears (Ramsay Hunt caused by H zoster)
Bilateral BP Recurrent BP Association with rash elsewhere or with feeling generally unwell (sarcoid or Lyme disease) Previous episode which might have been demyelination ?SOL
Treatment
Prednislone 1mg/kg up to 80mg max per day tailing off in second week (reduces oedema) Aciclovir 800mg 5x daily for 5days given within first 72hrs (prevents viral replication) Consider tape/eye pad so patient can sleep Consider prescription for artificial tears Reassure patient that he hasnt had a CVA
Follow up
2/3rds of patients have spontaneous recovery 85% show improvement in the first 3/52 15% show some improvement in 3-6/12 Refer all cases to ENT after initiating Rx Consider referral to eye specialist for tarsorrhaphy for those patients who have failed to make a complete recovery