Facial Paralysis in Cockers
Imagine waking up one day and noticing that your Cocker Spaniel looks like a Picasso painting, with one side of their face sliding off the canvas. Okay, maybe facial paralysis isn’t quite that severe, but it can be scary to see, especially if you’ve never dealt with it before. That’s what happened to me. I was grooming up my dog for her therapy visit at the local hospital when I noticed that half of her face was drooping significantly, and that her right eye looked really small compared to her left eye. I had noticed that her right eye looked strange earlier in the week, but had put it down to me being a paranoid owner. When I took Grace to the hospital for her therapy visit, she was drooling so much on the right side that I had to take a towel around with us to wipe her mouth in between residents. When I posted about this on Facebook, I got a wide range of responses from folks, including the suggestions that she’d had a stroke or a seizure. So, like any self-respecting dog owner, I got on the internet to see what I could find out (as well as making an appointment with my vet).
There is a lot of information on the net regarding idiopathic (translates to no known cause) facial paralysis in dogs. Obviously a person has to take everything they read with a grain of salt, since anybody can proclaim to be an expert on the World Wide Web. But this article is a summary of the information that I came across, in case you ever see this in one of your dogs.
The first thing you should do if you notice a droopiness or lopsidedness in your dog’s face is book an appointment with your veterinarian. Although it may appear to have no known cause, it’s best to have other possible causes ruled out. It turns out that Cocker Spaniels are one of the breeds most prone to facial paralysis, because of the long ears, the deep and steep ear canals, and the amount of ear infections the breed gets as a whole. If the facial paralysis is caused by an ear infection, your dog needs to be placed on antibiotics to clear out the infection and to prevent further damage to the inner ear, the ear drum or the ear canal.
The symptoms of facial paralysis are 1:
• Messy eating; food left around mouth
• Food falling from the side of the mouth
• Excessive drooling
• Inability to close eye; rubbing; discharge from eye
• Inability to close the eyelids
• Wide separation between the upper and lower eyelids
• Decreased or absent menace response and eyelid reflex
• Facial asymmetry
• Collapse of the nostril
• Chronic - patient may have deviation of the face toward the affected side
• Occasional facial spasms may be observed
• Discharge of pus from the affected eye
• Somnolence or stupor
The dog may have any or all of these symptoms. Diagnosis does not require that all symptoms are present. My dog had excessive drooling, inability to close her eyelid, lack of eyelid reflex and facial asymmetry.
Our visit to the vet included a history, a blood draw to check her chemistry levels (with a focus on thyroid), a Schirmer tear test to check for dry eye, and a very thorough scoping of the left ear canal, inner ear and a look at the ear drum. Some prick/sensation tests were done to determine the region lacking sensation as well. Some vets will recommend x-rays or an MRI to see what’s going on in the ear canal, especially if your dog objects to the scope being inserted into the ear. In this case the vet was able to see the ear drum, which was intact, and the inner ear, which was not red or inflamed at all, so my vet didn’t feel that an x-ray was warranted.
As most owners would, I wanted to know why my dog had this facial paralysis. Was it something I did or didn’t do? Was it something I could have prevented? The PetMD website 1 lists the following possible causes of facial paralysis:
• Idiopathic (unknown cause)
• Metabolic - hypothyroid
• Inflammatory - otitis media-interna: inflammation of the inner ear
• Nasopharyngeal polyps: benign growths that can occur in the back of the throat, the middle ear and even perforate through the ear drum – rare in dogs
• Trauma - fracture of a bone at the base of the skull; injury to the facial nerve
• Iatrogenic (physician induced) - secondary to surgical flushing of the external ear canal
When looking at this list, you can see why ruling out other causes can be important, rather than just assuming that the paralysis has no known cause. Also noted on the PetMD website is that two-sided facial paralysis is quite rare, although it’s not unusual for a dog with single-sided facial paralysis to experience some paralysis on the other side of the face in the future.
Treatment for idiopathic facial paralysis is waiting for the nerve to heal. If an inner ear infection or ruptured ear drum are the cause, then 4-6 weeks of strong antibiotics may be prescribed in order to fully clear out any bacteria and to give the tissues a chance to heal. The most important thing to note when the cause of paralysis is not known is whether or not the dog has an active blink reflex in the eye on the affected side of the face. If the dog is unable to close the eye, the eye will very quickly dry out, which could potentially lead to damage to the cornea or other eye tissues. For a dog without a blink reflex it is very important that the owner lubricate the eye at least 3-4 times a day, to protect the eye from damage 2. Unfortunately my dog lacks the blink reflex on the affected side, so she is getting lubricating gel applied in her eye three times a day. I have also been cautious when grooming to ensure that no trimmed hairs are left in the eye. A saline flush helped ensure that all debris was removed from the eye once grooming was complete.
The majority of the websites I visited stated that recovery from idiopathic facial paralysis can take from 4-6 weeks. My vet said the exact same thing, while also cautioning me that many dogs don’t recover completely. For some dogs whose nerves never heal, the facial muscles may start to contract due to lack of use, returning the dog’s appearance to normal. It is important that your dog sees the vet on a regular basis to monitor healing and improvement. If the dog’s blink reflex does not return, the owner will have to provide eye lubricant several times daily on a permanent basis.
Facial paralysis in Cockers can mimic other things, so another reason to see your vet is to ensure that you have an accurate diagnosis. A condition that looks very similar to facial paralysis is called Horner’s Syndrome, which is characterized by an eye that appears smaller than the other eye, and by an eyelid that droops, among other signs 3. Horner’s Syndrome is caused by injury to the nerve that supplies the affected eye. The majority of the time, Horner’s Syndrome is idiopathic, just like facial paralysis. The signs that separate Horner’s Syndrome from facial paralysis are a pupil that does not constrict or dilate in relation to light, and inflammation of the ear. Otherwise the two disorders are strikingly similar in appearance. Testing for Horner’s Syndrome in a dog presenting with facial paralysis is quite simple – the vet shines a light in the affected eye and watches the pupillary response. Initially, the vet suspected that my dog had Horner’s Syndrome but that turned out not to be the case.
Another disorder that needs to be differentiated from facial paralysis is a stroke. A stroke in dogs results from interruption of blood supply to the dogs’ brain, and it can be very serious. It’s very important to take your dog to the vet as soon as you suspect that a stroke may have occurred, because the sooner the diagnosis is made and treatment is started, the better your dog’s prognosis will be 4. Signs that your dog may have had a stroke ared:
• Lack of balance, sudden collapse
• Head tilt
• General state of weakness
• Lack of control over limbs and limping
A dog with a simple facial paralysis may be tired and more sleepy than normal, but they should not show a lack of balance, circling, confusion or a general lack of body control.
As you can see, although the sudden appearance of facial paralysis in your dog can be quite alarming, it is relatively harmless. There is the possibility of a corneal abrasion if the blink reflex is absent, but preventative care will minimize that risk. As with any changes in your dog’s appearance or behavior, the recommended course of action is to seek veterinary attention, to rule out other diseases or disorders.
As for Grace, well, within a couple of weeks her lip has tightened back up and she’s hardly drooling at all. She does still have a slight head tilt (which just adds to her charm, in my opinion) and she continues to lack a blink reflex. I just thank my lucky stars that this is a simple facial paralysis and nothing worse.
KLAD Cockers & Photographykladckrs@gmail.com
1. Face Nerve Paralysis in Dogs. http://www.petmd.com/dog/conditions/neurological/c_multi_facial_nerve_paresis
(3 February, 2012)
2. de Papp, Dr. Erika. Facial Nerve Paresis (Paralysis) in Dogs. http://www.petplace.com/dogs/facial-nerve-paresis-paralysis-in-dogs/page1.aspx
(3 February, 2012)
3. Droopy Eye In Dogs. http://www.petmd.com/dog/conditions/eyes/c_dg_horners_syndrome
(6 February, 2012)
4. Dog Stroke Prognosis. http://www.vetinfo.com/dog-stroke-prognosis.html
(6 February, 2012)