Patient information · Urgent care and neurology
Bell's palsy
steroids work — if they start within 72 hours
Bell's palsy is sudden weakness of one side of the face caused by inflammation of the facial nerve. It is frightening and is frequently mistaken for a stroke. Most people recover well, and treatment started within three days measurably improves the odds — which makes this a same-day problem.
Call 999 — this may be a stroke, not Bell's palsy — if there is
- facial weakness with the forehead still working (able to raise the eyebrow and wrinkle the forehead)
- arm or leg weakness, or numbness on one side
- slurred speech, or difficulty understanding
- sudden severe headache, confusion or drowsiness
- double vision, or difficulty swallowing
The distinction that matters: in Bell's palsy the whole side of the face is affected, including the forehead and eyelid. In a stroke the forehead is usually spared, because that part of the face has a nerve supply from both sides of the brain. If in any doubt, call 999. The nearest emergency department is the Royal London Hospital, Whitechapel Road, London E1 1FR.
What you may notice
- drooping of one side of the face, often coming on over hours and worst by 48 hours
- inability to close the eye on that side, or to blink
- drooling, food collecting in the cheek, difficulty drinking from a cup
- pain behind or below the ear, often a day or two before the weakness
- altered taste, and sounds seeming uncomfortably loud on that side
- a dry or watering eye
Treatment is time-limited
Oral steroids started within 72 hours of the weakness beginning significantly improve the chance of full recovery. After that window the benefit falls away. This is why Bell's palsy is a same-day appointment rather than something to see how it goes over the weekend. If there is a blistering rash in or around the ear, or severe ear pain, an antiviral is added — that combination suggests Ramsay Hunt syndrome, which has a poorer outlook and needs prompt treatment.
Protecting the eye — the part that causes lasting damage
If the eye will not close, the surface dries out and can ulcerate, which can permanently affect sight. This is the most important thing you do at home.
- Lubricating drops during the day, as often as hourly at first.
- Thicker ointment at night, when the eye is most at risk.
- Tape the eyelid closed at night, gently, with micropore tape — ask us to show you.
- Wear glasses or sunglasses outdoors to protect from wind and dust.
- Seek help the same day if the eye becomes red, painful or your vision changes.
Recovery
Recovery is usually gradual. A minority are left with some residual weakness, tightness, or involuntary movements — the eye closing when the mouth moves, for example. Facial physiotherapy helps, and forceful exercises early on are best avoided; gentle, controlled movement is more useful than effortful grimacing.
When to be reviewed
- no improvement at all after three weeks
- the eye becoming red, painful or vision changing — the same day
- weakness that is worsening after 72 hours, or that recurs
- any new neurological symptom
The 72-hour window is the reason to come to us rather than wait. We are open seven days a week, 9am–7pm, with same-day appointments most days and no referral needed — so treatment can start on the day it will do the most good. We can examine you, exclude the causes that need emergency care, prescribe steroids and eye protection immediately, show you how to tape the eye safely, and arrange physiotherapy and ENT or neurology input if recovery is slow.
Seen today — the treatment window is 72 hours
Same-day appointments seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.