Facial Palsy

Facial palsy means weakness or loss of movement in the facial muscles. It commonly results from a problem affecting the facial nerve, which carries signals from the brain to the muscles of the face.

It may affect:

• One or both sides of the face.
• The forehead, eye, cheek or mouth.
• Smiling and facial expressions.
• Blinking or closing an eye.
• Speaking, eating and drinking.

Bell’s palsy is a common cause of temporary facial weakness, usually affecting one side of the face. It often comes on quickly, over hours or a day or two.

Possible symptoms may include:

• Drooping or weakness on one side of the face.
• Difficulty smiling.
• Difficulty closing one eye.
• A dry eye, or an eye that waters.
• Drooling, or difficulty eating and drinking.
• Changes in taste.
• Pain around the jaw or behind the ear.
• Increased sensitivity to sound on the affected side.

Please do not try to diagnose Bell’s palsy yourself. Stroke and other conditions can cause very similar symptoms, and only a qualified healthcare professional can tell them apart.

Facial palsy can have a number of different causes, including:

• Bell’s palsy.
• Stroke or transient ischaemic attack.
• Ramsay Hunt syndrome (linked to the virus that causes shingles).
• Infection.
• Injury or surgery affecting the facial nerve.
• Neurological conditions.
• Tumours or growths affecting the nerve.
• Facial palsy that has been present from birth.

This list is not complete. Proper medical assessment is needed to establish the cause in any individual case.

A healthcare professional may ask:

• When the weakness started.
• Whether it began suddenly or gradually.
• Which parts of the face are affected.
• Whether there is arm weakness, speech difficulty, dizziness or any change in vision.
• Whether there is ear pain, a rash, or a change in hearing.
• Whether the person can close the affected eye.
• About recent infections, injuries, operations or other health conditions.

Tests or referrals to a specialist may sometimes be needed, depending on the symptoms and the suspected cause. Our GP Services page explains how appointments and referrals usually work.

Facial palsy can stop an eye from blinking or closing fully. Without the normal protection of blinking, the surface of the eye may become dry or damaged.

Get medical advice promptly about protecting the eye. Treatment might include lubricating eye drops, ointment, or safely closing the eyelid — but this must follow advice from a pharmacist, optometrist, GP, eye specialist or other qualified professional, who can choose what is right for the individual person.

Do not follow unverified instructions found online about taping an eye closed. Ask a qualified professional to show you what to do.

Treatment depends on the cause, and may include:

• Prescribed medication.
• Eye protection and eye care.
• Facial rehabilitation, such as facial therapy or exercises taught by a specialist.
• Speech and language therapy.
• Help with eating or drinking difficulties.
• Treatment of the underlying condition.
• Specialist procedures or surgery in some cases.

Recovery varies from person to person. Some people recover fully. Others experience continuing weakness, tightness, unwanted facial movements, or emotional difficulties. It is not possible to promise a particular recovery time or outcome, and anyone who does so should be treated with caution.

Some people find these practical suggestions helpful:

• Taking smaller bites.
• Eating slowly, without rushing.
• Choosing food textures that are easier to manage.
• Using a cup that is easier to control.
• Checking whether food has remained inside the affected cheek.
• Asking for professional help if swallowing or speech is difficult.

Facial palsy can affect confidence, communication, relationships, work and mental wellbeing. These effects are real and they matter, even when the physical symptoms are mild.

Because facial expressions have changed, other people may incorrectly assume what someone is feeling — reading a face as unfriendly, uninterested or upset when the person feels nothing of the kind. That misunderstanding can be tiring and isolating.

If you are experiencing anxiety, low mood, isolation or difficulty adjusting, please seek support. A GP can help, and our Mental Health page explains what is available. Facial Palsy UK also offers information and peer support for people living with facial palsy and their families.

Relatives, friends and colleagues can help by:

• Speaking directly to the person rather than making assumptions about them.
• Listening without staring or commenting on their appearance.
• Being patient if speaking or eating takes longer.
• Asking what practical support would actually help.
• Understanding that facial expression may not reflect how the person feels.
• Encouraging appropriate medical and emotional support.

Contact your GP or the specialist treating you if:

• Symptoms are getting worse.
• Recovery is not progressing as expected.
• The affected eye cannot close.
• There is continuing pain.
• Eating, drinking or speaking is difficult.
• New symptoms develop.
• Facial weakness returns.
• The condition is affecting your mental wellbeing.

Sudden new facial weakness must always be treated as a possible stroke and assessed urgently. Call 999.

• Stroke After-Effects — recovery, rehabilitation and support after a stroke.
• Mental Health — support for anxiety, low mood and adjusting to change.
• GP Services — booking, appointments and referrals.
• Find Local Services — official NHS finders for GPs, pharmacies, opticians and more.

• NHS — Bell’s palsy
• NHS — Stroke symptoms and FAST
• NHS — Stroke
• NHS — Cerebral palsy
• Facial Palsy UK
• Stroke Association — Signs and symptoms of stroke
• NHS inform (Scotland) — Facial palsy
• NHS inform (Scotland) — Stroke
• NHS 111 Wales — Bell’s palsy
• NHS 111 Wales — Ramsay Hunt syndrome
• nidirect (Northern Ireland) — Bell’s palsy
• nidirect (Northern Ireland) — Cerebral palsy

Important notice: This page provides general information only. It is not a diagnosis, medical advice, or a substitute for assessment and treatment by a qualified healthcare professional. Always speak to a GP or another qualified health provider about your own symptoms and circumstances. In an emergency, call 999.