Melissa Valdellon

Patient case for May 30, 2023

For today’s case, let’s talk about Bell’s Palsy.

A 50  year old Hispanic female came in with a complaint of vision changing on the left side for the last 1.5 months. She is currently using OTC +2.75 reading glasses, which aren’t working well. She also reports more photophobia, watering, and dull pain on the left side. She was diagnosed with Bell’s Palsy on the left side of her face since mid-February. Health-wise, there is nothing else going on and she is not taking any medications.

Uncorrected visual acuities are OD 20/20, OS 20/40 with no improvement on pinhole, retinoscopy, or refraction for the left eye. Confrontation  testing of pupils, EOMs, and fields are normal. IOPs are OD 17 mmHg, OS 16 mmHg.

Anterior segment findings show mild and equal mild meibomian gland dysfuction, 1+ NS, and vitreous syneresis of both eyes. In addition, the left eye shows a mild papillary response and significant NaFl staining response on the cornea, mostly the inferior half. Posterior segment was unremarkable in both eyes with C/Ds of 0.55 and 0.50.

How would you counsel this patient in terms of their symptoms and vision? What therapeutic recommendations would you make, and how soon would you like to see this patient back? How would you address their concerns about Bell’s Palsy in general? As always, leave your feedback in the comments below.

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