The FACE DROPS score is a clinical risk score used to help distinguish acute Lyme disease–associated facial palsy (LDFP) from Bell palsy at presentation, when treatment decisions may need to be made before Lyme testing is definitive. The difference matters because Bell palsy is typically treated with corticosteroids, while Lyme facial palsy requires antibiotics, and the role of steroids in Lyme facial palsy is less clear.

It is based on 7 clinical features:
Fever, Aches, Cephalalgia (headache), Exhaustion (unusual fatigue), Dermatomal/radicular pattern, Otalgia or postauricular pain, and Stiff neck. In the published model, most of these add points toward Lyme facial palsy, while otalgia/postauricular pain subtracts 1 point, which shifts the score toward Bell palsy.

The usual interpretation is:

• ≤4: favors Bell palsy
• 5–6: indeterminate
• ≥7: favors Lyme disease–associated facial palsy.

A simple way to think about it: higher FACE DROPS scores make Lyme facial palsy more likely; lower scores make Bell palsy more likely. It is a decision-support tool, not a replacement for full clinical assessment and Lyme testing.