Bell’s Palsy and Lyme Disease: Why Steroids May Do More Harm Than Good
Should steroids be used for Bell’s palsy? In typical cases, yes—but when Bell’s palsy is caused by Lyme disease, corticosteroids may increase the risk of long-term nerve damage.
Steroids and Lyme-Related Facial Palsy
A case series by Wormser and colleagues followed 11 patients with Lyme disease facial palsy, all treated with corticosteroids in addition to antibiotics.
More than half—6 of 11 patients (54.5%)—developed long-term facial nerve dysfunction, persisting an average of 13.1 months after treatment.
Complications included:
- Residual weakness
- Synkinesis
- Facial tightness
- Abnormal tearing (Bogorad’s syndrome)
What Is Synkinesis?
Synkinesis occurs when damaged facial nerves regenerate incorrectly, causing involuntary movements during voluntary actions.
For example:
- The eye may close when attempting to smile
- Facial muscles may contract unpredictably
This can significantly affect speaking, eating, and social interaction.
Bogorad’s Syndrome (“Crocodile Tears”)
Some patients develop gustatory lacrimation—tearing of the eye while eating.
This reflects misdirected nerve regrowth and indicates incomplete recovery of facial nerve function.
Long-Term Complications After Steroid Use
Patients in the study reported persistent symptoms affecting daily life:
- Facial asymmetry
- Eye dryness or excessive tearing
- Muscle tightness or twitching
- Difficulty speaking or eating
Some required surgical intervention.
Findings in Children
Children are also at risk.
One study found that 36.4% of children with Lyme-related facial palsy developed synkinesis following treatment that included corticosteroids.
This risk is not limited to adults.
Why Steroids May Be Harmful in Lyme Disease
Corticosteroids are standard treatment for idiopathic (viral) Bell’s palsy—but Lyme disease is different.
The underlying problem is infection—not inflammation alone.
Suppressing the immune response during active infection may:
- Delay bacterial clearance
- Worsen nerve injury
- Increase risk of long-term complications
This highlights the importance of recognizing Lyme disease early when evaluating facial paralysis.
Clinical Takeaway
Steroids may be harmful in patients with Lyme-related Bell’s palsy.
- Consider Lyme disease in any case of facial paralysis
- Avoid assuming all Bell’s palsy is viral
- Evaluate for tick exposure and associated symptoms
Early recognition can prevent long-term neurologic complications.
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
Does this also apply to other Lyme symptoms
Chronic complications of Lyme disease have been described after steroids.
Hello,
I am a medical student in england. I was in Facial paralysis 1 week ago. Boriella IgM +. I use doxycycline and streoid. What is your suggestion?
I am sorry to hear you are having problems finding the best answer. Doctors in the US tend to prescribe steroids in case the problem is due to a virus. The article I referred to in the Blog describes the consequences of that protocol. I treat my patients clinically. The Bell’s can last awhile. I treat longer if my patient is taking steroids and if there are other symptoms.
My 4 year old is being treated for Lyme and Bell’s Palsy with Doxycycline. Is that enough or should he also be on Prednisone? What else can I do to help the recovery from Bell’s?
Steroids have been helpful for Bell’s palsy due to a virus. It is not clear whether steroids are helpful if the cause Lyme disease. I have been reluctant to use steroids if Lyme disease is the cause.
My 6 year old son has a same kind of symptoms last 2 days, his left side eye since yesterday tearing,hard to close,it doesn’t blink, and his mouth crooked,he doesn’t have any kind of infection except this type of symptoms,I hope your going to make me happy give me right suggestions
That could be Bell’s palsy. You will need to have your son evaluated by a doctor or an ER.
Steroidal therapy can suppress patients’ immune systems, allowing the Borrelia and other co-infections to grow, rather than attacking the infections. You may ask why patients are given steroids like prednisone. The answer is because Lyme is often misdiagnosed as autoimmune diseases, such as fibromyalgia.
I took my daughter to the ER on Friday because she was experiencing facial paralysis (it was a slow progression and she was now on Day 5 of it). They put her on 20 ml of prednisone for 5 days; 15 ml of prednisone for 3 days; and then continuing to wean after that. Her blood work came in today, Monday, and she tested positive for Lymes. I gave her her dose of prednisone tonight but I am worried!! Should I have? She sees a DR tomorrow late afternoon to get on an antibiotic for the Lymes. Should I ask her to get off the prednisone? Can she get off it without being weaned since she is only on day 4 of it? Please advise. Thanks very much.
I have had patients who were started on Prednisone before being diagnosed with Lyme disease. I typically start on an antibiotic if Lyme disease is a consideration. I can’t comment on whether the steroid can be stopped. I am glad to hear your will see a doctor tomorrow.
I got Bell’s palsy about 2 yes ago but never went to the doctor but I still have some symptoms like eye waters when I eat and don’t have full sensitivity on left side of my face I’m wondering if taking ivermectin would help?
I have not seen any studies using ivermectin. You might find my blog helpful. https://danielcameronmd.com/bells-palsy-and-lyme-disease/ or work with neurology/EBT