Bell’s Palsy Treatment: Medication, Eye Protection, Physical Therapy and What the Evidence Says

After diagnosis, most people want to know which Bell’s palsy treatment will bring their face back as quickly as possible. The good news: most cases improve, and there are clear, evidence-based steps. This guide summarises what clinical guidelines say, in plain language.

This article is for education only. Your doctor decides the medicine, dose and duration after examining you.

1. Corticosteroids: what matters most in the first 72 hours

Oral corticosteroids such as prednisolone are the mainstay of Bell’s palsy treatment. They reduce swelling and inflammation around the nerve inside its narrow bony canal.

• The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) guideline recommends starting them within 72 hours of onset for patients aged 16 and over.
• A large trial published in the NEJM found that early prednisolone clearly increased the rate of complete recovery at 9 months compared with no prednisolone.
• People with diabetes, pregnant women and those with chronic conditions need extra monitoring while taking them.

2. Antivirals: when do they help?

Since viruses may play a role in what causes Bell’s palsy, people often ask about antivirals:

• On their own, they are not effective and are not recommended as a single treatment.
• A doctor may add them to steroids in severe cases; reviews suggest any extra benefit is small.
• They become essential if Ramsay Hunt syndrome is suspected.

3. Eye protection: part of treatment, never optional

When the eye doesn’t close properly, its surface dries out and the cornea can be damaged. Treatment usually includes:

• Artificial tears several times a day.
• Lubricating ointment at bedtime.
• Medical tape or a moisture shield to keep the eye closed at night.
• Glasses to protect against wind and dust.

Full details in our eye care guide.

4. Physical therapy and facial exercises

Once the early inflammatory phase settles, rehabilitation takes over. The goal isn’t to “strengthen” muscles at any cost, but to retrain correct, balanced movement:

• Slow, precise exercises in front of a mirror for the forehead, eyes and mouth — see our facial palsy exercises guide.
• Facial massage to relax tight muscles.
• Control exercises to reduce synkinesis.

A Cochrane review notes that the evidence is still of limited quality, but guided exercises appear helpful, especially for improving movement and reducing complications. The evidence for electrical stimulation is weaker.

5. What if there’s no improvement?

If there is no improvement at all after 3–4 months, or complications develop, your doctor may suggest:

• Re-assessment and tests such as nerve conduction studies or imaging to rule out other causes.
• Botox injections for synkinesis or tightness on the healthy side.
• Specialist facial physiotherapy.
• Facial reanimation surgery in a small number of selected cases.

To measure severity and track progress, doctors use scales such as House–Brackmann — explained in facial palsy grading scales.

Popular treatments without enough evidence

• Cupping and cauterisation: no proven benefit, with risks of burns, scarring and infection.
• Herbs and home remedies: may interact with medication — check with your doctor first.
• Chewing gum and forceful exercises: can strengthen the healthy side at the expense of the affected one.

A quick practical plan

Phase	What to do
First 72 hours	See a doctor, take prescribed steroids, protect the eye
Weeks 1–2	Rest, eye care, very gentle exercises once your doctor agrees
Week 3 onwards	Regular precise exercises, massage, progress tracking
After 3 months	Re-assessment if improvement is limited

Raq is designed to support the rehabilitation phase: a structured 3-month plan that progresses week by week, video and voice guidance for every exercise, and real-time AI guidance through your camera to help you move precisely and symmetrically. Raq supports your doctor’s plan — it doesn’t replace it.