Why I’m Wearing an Eye Patch


Choose from among the following:

  • A) I like costumes.
  • B) I really wanted to look like Samuel L Jackson.
  • C) It’s an interesting (and humbling) learning experience, walking around with one eye.
  • D) The left half of my face is paralyzed.

If you chose E, “All of the Above” (option not shown) you win!

What Happened

The last few weeks have been a little more hectic than normal. I woke up in Mountainview on Wednesday, at NASA Ames, having just recorded videos the previous day on energy innovation and climate disruption for Singularity University (we’re working to put more of our curriculum into a video form to reach more people).

My upcoming schedule looked like this:

  • Wed:           Fly to LA. Give important talk to utility executives on energy innovation.
  • Wed night:  Red eye to Miami.
  • Thursday:   Keynote the awesome Smart City Startups Miami conference. (It was awesome. Truly. I’ve seldom been so inspired.)
  • Friday:        Home to Seattle.
  • Sunday:      Fly to Denmark for 4 days of energy-related talks, media interviews, and dinners with awesome people.
  • Next week: Next novel comes out. Speak in SF. Speak in Las Vegas. Launch event in Seattle.

Sometimes life decides things are going to change. That Wednesday morning, the left side of my mouth didn’t work too well. My left eye didn’t work too well, and was, in fact, burning up. I had full sensation. But movement was sluggish, like I’d just come from the dentist. My speech was a little slurred. Drinking was… awkward.

I did not have a stroke.

Bell’s Palsy and How to Treat It

What I have is much less serious. It’s Bell’s Palsy. The facial nerve that controls the muscles of the left side of my face is inflamed, probably from an infection. That, in turn is cutting off signals. The large majority of cases of Bell’s Palsy resolve on their own within 3 to 6 months, and many (particularly mild cases) show some sign of improvement within 2 weeks.

[If you think you have Bell’s Palsy, get treatment fastideally within the first 48 hours. More below.]

I gave my talk in LA, still not 100% sure how to deal with the dryness in my eye. That dryness is caused by an inability to close the eye fully + paralysis of the mechanisms that would normally lubricate the eye with tears. But I told the audience I was a bit under the weather, I was able to enunciate well enough (with difficulty and focus), and the talk seemed to be a success.

In Miami I saw a physician and started prednisone (an oral steroid) to bring down inflammation of the nerve. If you or someone you know comes down with Bell’s Palsy, prednisone is virtually the only treatment (besides rest) that is shown to make a difference.

  • At three months, 83% of patients given prednisone within 72 hours of symptoms have recovered fully, compared to 64% of patients not given prednisone.
  • At nine months, 94% of patients given prednisone within 72 hours of symptoms have recovered fully, compared to 82% of patients not given predisone.
  • Reference for the above.
Other studies suggest the real treatment for Bell’s Palsy is the first 48 hours. More on that below.
Another study with more stringent criteria found the total recovery numbers a bit lower, but again with a very real impact of prednisone. They found a 60% chance of complete recovery without medication, and 75-80% with prednisone. You can see a graph of recovery rates below. That means cutting your risk of lasting damage roughly in half. 



Most clinical guidelines suggest that starting prednisone within 72 hours, at the latest, seems to be critical to making an impact. After 72 hours, the impact of steroids seems to be far reduced. Other studies suggest that up to a weak after symptoms, there’s a chance of benefit.

But a study in 2011 looked more closely, and found that the critical window is the first 48 hours. So if this happens, see a doctor immediately, tell them you suspect Bell’s Palsy, point them at the clinical recommendations, and fairly insist on a strong and immediate dose of prednisone. [Unless, of course, there’s a medical reason you can’t take oral steroids, or the doctor convinces you that you don’t actually have Bell’s Palsy.]

Here’s a quote from that paper finding the first 48-hour window is critical in treating Bell’s.

Patients treated with prednisolone within 24 hours and within 25 to 48 hours had significantly higher complete recovery rates than patients given no prednisolone. For patients treated within 49 to 72 hours of palsy onset, there were no significant differences [vs patients given no prednisolone].

(Axelsson et al 2011). More general write-up here.

How I’m Doing

That’s enough on the medical side. How, you ask, am I?

Well, I’m just trying to have fun.

Here’s me at Smart City Startups.

Where I had to show a slide to quash a rumour that I’m actually Samuel L. Jackson (despite both of us being tall, handsome, rich, and famous, and no one having seen us in the same room together).

I did cancel the trip to Denmark, for which I apologize profusely to everyone I was planning to see there. There were an amazing set of talks lined up, but it’s clear that rest, especially in the early stages of the disease, maximizes the odds of full recovery. That trip will be rescheduled, and I’m looking forward to it.

More than anything else, I’m trying to take it easy and make light of what is, most likely, a temporary inconvenience. So what the heck, here are a few recent photos. I think I look rather dashing in an eyepatch, actually.  (Though I need to work on my good-eye-glare and my photoshopped backgrounds).

A Note of Empathy

One last note:

Living with this, even for the last week, has made me aware of the difficulties that people who are even partially blinded or who suffer from any sort of facial paralysis or scarring face. It seems rather trivial, but my field of vision is narrower while I’m protecting the left eye. My depth perception is gone. I’m constantly being surprised by things. And my face… Well, when I pose well, it looks great. When I laugh? Oh my lord. I think I’ve scared small children. And elicited more than my share of stares. So my compassion and empathy for anyone who suffers any sort of facial issue has seen a boost.

And, beyond that, I’m acutely aware that I’m privileged to be male. That’s true in so many parts of life, but it’s specifically true in this case. In a society that places a far larger premium on looks (and specifically, looking “pretty”) for women, I suspect the emotional and societal cost is likely higher on most women suffering from this from most men, and that my gender is making it far easier for me. That’s another thing I’ll be thinking about.

Thanks for reading along. Hopefully I’ll be well in a few weeks. I don’t plan to cancel any more events, at any rate, so if you see me in public, you’ll be getting a one-eyed, lopsided grinning, wild-man looking Ramez Naam.

And in the meantime, if you want the cerebral version of me, you can always pre-order Apex, the last of the Nexus trilogy.