FACE DROPS

• Results of this tool should augment, not replace, clinical judgment.

• For scores ≥5, exclude other tick-borne diseases and HIV, which can present with systemic symptoms and peripheral facial palsy.

• Examine the external auditory canal in all patients with peripheral facial palsy to assess for vesicles diagnostic of Ramsay-Hunt syndrome.

Score ≤4: Bell palsy is more likely.

• Consider starting corticosteroids.
• Antiviral therapy may be considered for severe cases.
• Provide eye care.
• Consider Lyme testing based on geography/exposure.
• Antibiotics may be deferred absent other objective Lyme evidence.

Score 5–6: Unclear predictive value.

• Apply clinical judgment.
• Management of both Lyme disease and Bell palsy may be appropriate while further workup is pending.

Score ≥7: Lyme disease-associated facial paralysis is more likely.

• Start antibiotics now.
• Avoid corticosteroids.
• Follow-up Lyme serology.

• Oral antibiotics are appropriate for isolated LDFP; use intravenous therapy when there are other severe neurologic manifestations.
• Early Lyme disease can be seronegative; serology studies can support the probability of a diagnosis but should not be used to rule in/out a diagnosis.
• Weakness restricted to the lower face should prompt consideration of a central cause of facial weakness, including stroke.