Can shingles cause Bell's palsy?

Shingles can cause one-sided facial weakness, although this is often called Ramsay Hunt syndrome rather than typical Bell's palsy. Both conditions involve the facial nerve, which controls movements such as smiling, closing the eye and raising the eyebrows. Shingles-related facial weakness may occur with a painful blistering rash around the ear, in the ear canal or on the face; ear pain, hearing changes or dizziness can also occur. A clinician needs to examine you because facial weakness has other possible causes, and treatment is time-sensitive.

Bell's palsy describes sudden weakness or paralysis of the facial muscles, often without an identified cause. When the varicella-zoster virus reactivates near the facial nerve, the resulting problem is usually described as Ramsay Hunt syndrome. A rash may be obvious, subtle or absent at first, so the absence of visible blisters does not settle the diagnosis. The pattern of weakness, skin and ear findings, and other neurological signs helps a clinician distinguish these conditions.

Arrange same-day medical assessment for new facial weakness, especially if you have a painful rash, ear symptoms or recent shingles symptoms. Antiviral treatment may be considered for shingles, and a clinician may discuss other treatment depending on the examination and timing. Until you are assessed, protect an eye that does not close fully by avoiding dust and rubbing; ask a pharmacist or clinician about suitable lubrication and eye protection. Do not put creams or objects into the ear unless advised.

Seek emergency help immediately if facial drooping comes with weakness or numbness in an arm or leg, trouble speaking, confusion, severe headache, fainting, new vision problems or difficulty walking. These features can indicate a neurological emergency rather than an isolated facial nerve problem. Urgent assessment is also needed for severe eye pain, a red eye, reduced vision, inability to close the eye, or a rash near the eye or inside the ear.

Ask whether the pattern is more consistent with Bell's palsy, shingles-related facial nerve inflammation or another cause. You can also ask whether your eye needs protection, whether an ear or eye examination is needed, which symptoms should prompt emergency help, and when follow-up should occur if movement does not begin to return. Mention any ear pain, rash, hearing change, dizziness, recent illness or new medicines.