Can Facial Palsy from Lyme Disease Be Permanent?
Persistent facial weakness after Lyme disease
Residual symptoms may occur despite treatment
Long-term recovery varies among patients
Most people with Lyme disease facial palsy recover completely following appropriate antibiotic treatment. However, some patients continue to experience facial weakness, abnormal facial movement, eye symptoms, or facial twitching months after treatment. These persistent symptoms may reflect residual facial nerve injury rather than persistent infection. Several studies have examined these long-term outcomes and help explain why recovery may be incomplete in some individuals.
In their study, Wormser and colleagues found that 6 of 11 Lyme disease patients (54.5%) experienced persistent facial nerve dysfunction an average of 13.1 months after treatment. These patients had received corticosteroids during their illness.1 The average follow-up of more than one year highlights that facial nerve deficits may persist long after the initial infection has resolved.
What residual symptoms were reported?
- 52-year-old man with “tearing of left eye when eating (Bogorad’s syndrome); mild residual weakness left side.”
- 51-year-old man with “mild residual left sided weakness; dryness left eye; after speaking a lot, left sided facial muscles feel abnormal.”
- 56-year-old man with “narrowed palpebral fissure right eye; dry mouth; sensation of muscles around right eye being squeezed; tearing of right eye; twitching of the area between the eyes on the forehead; new dimple right cheek; intermittent lisp.”
- 25-year-old man with “narrowed palpebral fissure left eye; reduced forehead movement; right sided jaw discomfort with eating; tearing of the left eye when eating (Bogorad’s syndrome).”
- 61-year-old man with “narrowed palpebral fissure right eye; difficulty whistling; right eye discharge at night.”
- 70-year-old woman who had “surgical facial nerve decompression nearly 3 months after onset of the LDFP (Lyme disease facial palsy).”
These cases demonstrate that some patients may continue to experience facial weakness, abnormal facial movement, tearing, eye discomfort, or jaw symptoms despite treatment. While many patients recover fully, others have persistent deficits that may affect daily activities and quality of life.
Residual symptoms involved both facial weakness and abnormal facial nerve regeneration, resulting in functional and cosmetic concerns.
Can facial palsy from Lyme disease be permanent?
Most patients recover well after Lyme disease facial palsy, particularly when treatment is started promptly. However, some individuals develop long-term complications including residual facial weakness, facial synkinesis, incomplete eyelid closure, tearing while eating (Bogorad’s syndrome), or abnormal facial muscle movements. Recovery may continue for many months, but some patients experience long-term residual deficits.
“Facial synkinesis presents following injury to the facial nerve and manifests as involuntary movement during voluntary or spontaneous movement. This phenomenon may become clinically apparent 3 to 4 months following facial nerve injury,” wrote Shokri and colleagues.2
Can Lyme disease cause eye twitching?
Yes. Some patients develop eye twitching or involuntary facial muscle contractions during recovery from Lyme disease facial palsy. These symptoms are thought to reflect abnormal regeneration of the facial nerve or facial synkinesis rather than persistent infection.
Additionally, LeWitt described a case of hemifacial spasm (HFS) associated with Lyme disease and concluded that “Because its diagnosis can be occult and antibiotic therapy can be both diagnostic and therapeutic, Lyme disease should be a consideration for cases of HFS.”3
Ramsey and colleagues found that approximately 10% of patients presenting with acute peripheral facial palsy had Lyme disease, emphasizing the importance of screening in endemic regions.4
The authors recommended screening patients with acute peripheral facial palsy for Lyme disease in endemic areas because early diagnosis can affect treatment decisions.
“We recommend screening patients with APFP for associated and treatable factors, especially Lyme disease in regions where the disease is endemic.”4
Frequently Asked Questions
Is facial palsy from Lyme disease permanent?
Most patients with Lyme disease facial palsy recover completely after appropriate antibiotic treatment. However, some individuals continue to experience residual facial weakness, synkinesis, tearing, eye symptoms, or other facial nerve abnormalities months or even years after treatment. Recovery varies depending on the severity of nerve injury and individual factors.
Can Lyme disease cause eye twitching?
Yes. Eye twitching or involuntary facial muscle contractions may occur during recovery from Lyme disease facial palsy. These symptoms are often related to facial nerve regeneration or facial synkinesis rather than persistent infection.
Can Lyme disease cause facial numbness?
Yes. Lyme disease may affect several cranial nerves and can lead to facial numbness, tingling, or altered sensation in some patients. Facial numbness may accompany facial palsy or occur independently in Lyme neuroborreliosis. Because facial numbness has many possible causes, evaluation by a healthcare professional is important.
How long does Lyme disease facial palsy last?
Many patients improve over weeks to months following appropriate antibiotic treatment. While most recover fully, some continue to experience facial weakness, abnormal facial movement, synkinesis, or eye symptoms for a year or longer.
Clinical Takeaway
Most patients with Lyme disease facial palsy recover completely, particularly when appropriate antibiotic treatment is started promptly. However, some individuals experience persistent facial weakness, synkinesis, tearing, eye twitching, or other facial nerve abnormalities that may continue for months or longer.
Patients with incomplete recovery should be evaluated for residual facial nerve dysfunction and managed appropriately. Long-term follow-up may help identify complications such as synkinesis, hemifacial spasm, or chronic eye symptoms that can affect function and quality of life.
Although complete recovery is common, Lyme disease facial palsy can result in long-term residual facial nerve dysfunction, underscoring the importance of early diagnosis, appropriate antibiotic treatment, and continued follow-up when symptoms do not fully resolve.
Related Articles
Can Bell’s Palsy Lead to Nonflaccid Facial Palsy in Lyme Disease?
Patient with Facial Palsy from Lyme Disease Fails Treatment
Can Lyme Disease Cause Eye Twitching?
Treatment Varies for Bell’s Palsy in Children with Lyme Disease
References
- Wormser GP, McKenna D, Scavarda C, Karmen C. Outcome of facial palsy from Lyme disease in prospectively followed patients who had received corticosteroids. Diagn Microbiol Infect Dis. 2018;91(4):336-338.
- Shokri T, Azizzadeh B, Ducic Y. Modern Management of Facial Nerve Disorders. Semin Plast Surg. 2020;34(4):277-285.
- LeWitt TM. Hemifacial Spasm From Lyme Disease: Antibiotic Treatment Points to the Cause. Clin Neuropharmacol. 2016;39(6):329-330.
- Ramsey DJ, Haas LP, Tucker SM. Long-term Outcome After Acute Peripheral Facial Palsy. Ophthalmic Plast Reconstr Surg. 2022.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I’ve seen where some doctors believe this could be helped by botox. What say you ?
I had Bell’s palsy, and tongue and jaw spasms, along with burning mouth, tooth, and gum pain. I finally realized I have trigeminal neuralgia. This is about 3 years after getting bitten by a black-legged deer tick, and contracting Lyme disease.
Welcome to the club. I dont know why the left side is more effected then the right, maybe because it’s the weaker side.
We need a cure!
I have tearing in my left biceps, pain in shoulder up to my neck, feels like radiculopathy, left cheek feels like it has cobwebs over it and occasional itchy eyes and itchy feet. The most recent symptom is De Quervains, a very painful condition that effect the thumb of either both hands, also more effected on the left side.
I wish someone could make sense of what it particular this disease is targeting so I can centralize the pain management process. Is it the nerves, the tendons, the root nerves, peripheral, small fiber nerves,
HEEELP!
Have facial nerve damage on face after 9 years of Lyme disease. Have gone to John Hopkins to Dr. Alcott and still live with this terrible desease.