A Simple Guide to Facial Palsy

A Simple Guide to Facial Palsy
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What is Facial Palsy?
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Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.

It is usually temporary.

What are the causes of Facial Palsy?
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Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:

Supranuclear(within the Brain)
1.Cerebral vascular lesions

2.Cerebral tumours

Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.

2.Trauma- Birth injury,fractured temporal bone, surgery of the ear

3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease

5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,

6.Multiple sclerosis

What are the symptoms and signs of Facial Palsy?
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The onset of facial palsy is usually very sudden.

The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.

Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations

2.Depressed taste ( lesion above chorda tympani)

3.hyperacusis ( lesion above nerve to stapedius)


Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.

2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.

3.dribbling of saliva

4.difficulty in speaking

5.loss of taste at the front of the tongue

6.dryness or watering of the affected eye

7.eyeball rolled up and inward on attempted closure of affected eye

8.ectropion or turned out lower eyelid

9.sharp hearing on the affected side

10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.

What are the investigations required in Facial Palsy?
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1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)

b.test closing of the eye - to test weakness of eyelid muscles

c.ask patient to smile - to check for weakness of the cheek muscles

2.Investigations:
a.Blood for infections, HIV, Lyme's disease

b.MRI of brain to exclude tumours

c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Facial Palsy?
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1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.

The steroid usually reduce swelling of the nerve.

2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus

3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.

Use artificial eyedrops during the day to keep the eye moist.

Tape the eye at night to keep it closed.

4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.

5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.

Plastic surgery may improve permanent facial drooping

What is the prognosis of Facial Palsy?
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80-90% of patient with facial palsy recover spontaneously and completely within three weeks.

The remainder usually takes up to six months to recover.

Very rarely do you get permanent paralysis of the facial nerve.

A Simple Guide to Conjunctivitis

A Simple Guide to Conjunctivitis
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What is Conjunctivitis?
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Conjunctivitis is an inflammation of the conjunctiva(the white of the eye and inner lining of eyelids).
It is one of the most common and treatable eye infections in children and adults.

What causes Conjunctivitis?
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Conjunctivitis can be caused by a
virus
bacteria
irritating substances (shampoos, dirt, smoke, and especially pool chlorine)
allergens (substances that cause allergies).

Conjunctivitis caused by bacteria, viruses can spread easily from person to person, but is not a serious health risk if diagnosed promptly.

What are the symptoms of Conjunctivitis?
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1.Redness in the white of the eye or inner eyelid

2.tears overflowing

3.yellow discharge that crusts over the eyelashes, especially after sleep
Other discharge from your eye (green or white) .

4.Pain in the eye

5.Itchy eyes (especially in conjunctivitis caused by allergies)

6.Burning eyes (especially in conjunctivitis caused by chemicals and irritants)

7.Blurred vision

8.sensitivity to light

How is Conjunctivitis spread?
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Bacterial or viral Conjunctivitis can also be spread through hand contact when rubbing the eyes or touching contact lenses after touching infected skin.

Being around a person who has conjunctivitis and wearing contact lenses may increase your risk of getting conjunctivitis, but the outcome is usually very good with treatment.

How is Conjunctivitis treated?
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Bacteria:Conjunctivitis caused by bacteria is treated with antibiotics.
The antibiotic can be given as eye drops, ointments, or pills.
Eye drops or ointments may need to be applied to the inside of the eyelid three to four times a day for five to seven days.

Virus: No Medicine can treat conjunctivitis caused by a virus.
This type of conjunctivitis often results from a common cold.
You may, however, help relieve symptoms by applying a cold compress.

Irritating substance:For this type of conjunctivitis, use warm water for five minutes to wash the irritating substance from the eye.

Allergies:Allergy-associated conjunctivitis is treated with antihistamines or when the allergen is determined and removed.

How to relieve symptoms of Conjunctivitis?
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1.Protect your eyes from dirt and other irritating substances.

2.Do not use contact lenses, if you wear them.

3.Place cold compresses on your eyes.

4.Wash your face and eyelids with mild soap or baby shampoo and rinse with water to remove irritating substances.

5.Do not rub your eyes with hands that are not washed.

6. Do not use the same bottle of drops in the other eye if it is not infected.

How to prevent spreading Conjunctivitis?
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1.Do not touch or rub the infected eye(s).

2.Wash your hands often with soap and warm water.

3.Wash any discharge from your eyes twice a day using a fresh cotton ball or paper towel. Afterwards, discard the cotton ball and wash your hands with soap and warm water.

4.Wash your bed linens, pillowcases, and towels in hot water and detergent.

5.Avoid wearing eye makeup.
Don’t share eye makeup with anyone else.

6.Do not wear another person’s contact lens.

7.Wear glasses instead of contact lenses.
Throw away disposable lenses or be sure to clean extended wear lenses and all eyewear cases.

8.Avoid sharing common articles such as unwashed towels, cups, and glasses.

9.Wash your hands after applying the eye drops or ointment to your eye or your child’s eye.

10.Do not use eye drops in a non-infected eye that were used for an infected one.