Ophthalmology

Unit 3: Pupil Abnormalities, Facial Nerve Palsy & Ptosis

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4: Facial (7th Cranial) Nerve Palsy

Photo of a patient with Bell's palsy. which can be seen by the upward and outward position of this patient's right eye.

Source: EyeRounds.org Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry.

Causes

  • Brainstem disease
  • Skull base disease
    • Tumours
    • Meningeal disease
  • Peripheral disease
    • Herpes zoster
    • Middle ear disease
    • Mastoiditis
    • Parotid tumours
  • Sarcoid (peripheral or meningeal)
  • Trauma or surgery
  • Idiopathic (Bell's palsy) (over 75%)

Clinical Features

  • Paralysis of the facial muscles
  • Widened palpebral aperture
  • Impaired eyelid closure
  • Drooping of the angle of the mouth

Examination

Examine cranial nerves, especially 5th and 6th, and middle ear (otoscopy)

Management

  • Consider referral to ENT.
  • Refer for neuroimaging if:
    • Associated neurological features
    • Failure to resolve after 3 months
  • Refer to ophthalmology if:
    • Corneal exposure
    • Epiphora (watering)
    • Cosmetic concerns