Bilateral Facial Nerve Palsy After Covid Vaccination

To report a case of bilateral Bell's palsy 2 weeks after covid vaccination that ended to corneal perforation caused by neurotrophic keratitis.

Case report

A 68-year-old caucasian female presented to the emergency ophthalmology department with bilateral facial weakness. She had difficulty with speech, swallowing, and she was unable to fully close her eyes. She reported no prior history of COVID-19 infection but reported receiving Pfizer-BioNTech COVID-19 vaccine approximately two weeks prior to the initial presentation. She denied any family or surgical history. She denied home medication. She denied alcohol consumption, tobacco and illicit drug use. Slit lamp examination revealed corneal melting of her right eye and corneal perforation of her left eye caused by neurotrophic keratitis. We induced autologous serum eye drops to her right eye and we applied cyanoacrylate glue corneal patch for the management of corneal perforation. The differential diagnosis for bilateral Bell's palsy includes sarcoidosis, Lyme disease, Guillain-Barré, trauma, tumor and encephalitis; all of which were excluded with serological analyses, cerebral spinal fluid analyses, imaging, history of present illness, and physical exam.  The patient was subsequently discharged with neurology outpatient follow-up. 

Idiopathic bilateral facial nerve palsy is very uncommon. Our patient developed bilateral facial nerve palsy 2 weeks after COVID-19 vaccination ended to a sight threatening complication. Guidance and frequent monitoring are required for these patients.