Which of the following does NOT occur in Bell palsy?

Correct answer: B. Glaucoma

• A. Inability to close the eye (lagophthalmos) results from paralysis of orbicularis oculi and is a defining feature of a lower motor neuron facial palsy.
• B. CORRECT — this is the EXCEPT. Glaucoma is a disorder of intraocular pressure and optic nerve damage. It has no relationship to facial nerve palsy. The ocular problem in Bell palsy is EXPOSURE keratitis from failure of eyelid closure, which is an entirely different mechanism.
• C. Flattening or loss of the nasolabial fold on the affected side is a classic sign.
• D. Drooping of the oral commissure with drooling and difficulty retaining fluids follows paralysis of the perioral musculature.

Note: Eye protection is the urgent management priority: artificial tears through the day, lubricating ointment and taping or a patch at night. Corneal ulceration from exposure is the most serious avoidable complication. Other features to expect are hyperacusis from stapedius paralysis and loss of taste on the anterior two-thirds of the tongue from chorda tympani involvement — both help confirm the lesion level.