Executive summary
- Acute LMN facial weakness (forehead involved) with no other neurology suggests Bell's palsy — but exclude stroke/secondary causes.
- Consider prednisolone if presenting within 72 hours (dose per local protocol).
- Prioritise eye protection if incomplete lid closure (lubricants + night protection; urgent ophthalmology if corneal risk).
Red flags (urgent escalation)
- Forehead sparing, other neurological deficits, gradual progression, recurrent/bilateral palsy, vesicular rash (Ramsay Hunt), severe headache/ataxia, systemic malignancy signs.
- Consider Lyme disease based on exposure/geography; test per local policy if risk.
Follow-up and referral
- Review if not improving by ~3 weeks or incomplete recovery by ~3 months; refer earlier if diagnostic uncertainty.
- Physio/facial retraining may help persistent weakness/synkinesis (local pathways vary).
Frequently asked questions
How is this different from stroke?
Bell's palsy is LMN (forehead involved). Stroke often spares the forehead and has other neuro deficits. If unsure, treat as stroke and escalate.
What is the most important management step?
Eye protection to prevent corneal injury.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.