What is the recommended management protocol for a patient diagnosed with Bell's Palsy in primary care?

Recommended management protocol for Bell's Palsy in primary care:

• Confirm diagnosis of Bell's Palsy as a unilateral lower motor neurone facial weakness affecting all parts of the face, excluding other causes such as stroke, cancer, trauma, or infection; urgent referral is required if atypical features or other neurological signs are present ¹.
• For adults presenting within 72 hours of symptom onset, initiate oral corticosteroid therapy, typically prednisolone 50 mg daily for 10 days or a tapering regimen starting at 60 mg daily, as corticosteroids significantly improve facial nerve recovery and reduce incomplete recovery rates ¹ (Baugh et al., 2013).
• Do not routinely prescribe antiviral treatment alone; combined corticosteroid and antiviral therapy may have a small additional benefit but should only be considered after specialist advice due to limited and conflicting evidence ¹ (Baugh et al., 2013; de Almeida et al., 2014).
• Provide comprehensive patient education on prognosis, emphasizing that recovery varies and may take several months, and advise on self-care measures including eye protection and care to prevent corneal damage: use lubricating eye drops during the day, eye ointment at night, tape the eye closed if unable to close it, avoid eye patches, and protect the eye from irritants such as dust and swimming ¹.
• Advise on practical measures for eating if facial weakness affects oral intake, such as using a straw for liquids and consuming soft foods ¹.
• Routine laboratory or imaging investigations are not required unless symptoms persist beyond 3 weeks without improvement, or if recurrence or atypical features develop, in which case referral to a facial nerve specialist is warranted ¹.
• Refer urgently if no improvement after 3 weeks, if neurological symptoms worsen, or if incomplete recovery persists after 3 months ¹.
• Consider referral to ophthalmology if ocular symptoms such as pain, irritation, or vision changes develop at any time ¹.
• Physical therapy, including facial exercises, currently lacks strong evidence for routine recommendation but may be considered on a case-by-case basis; further research is needed to clarify its role (Baugh et al., 2013; Khan, 2022).