Eyelid surgery

What is eyelid surgery?

Eyelid surgery (or blepharoplasty) is a surgical procedure performed to correct puffy bags below the eyes and droopy upper eyelids. It can improve appearance and widen the field of peripheral vision.

Many people acquire excess skin in the upper eyelids as part of the process of ageing and this may be considered normal. However, if this starts to interfere with vision or function of the eyelid then this can warrant treatment. This procedure will be funded by the NHS to correct functional impairment but the following eye lid procedures will not be funded:

  • Surgery for cosmetic reasons
  • Surgery for yellowish cysts containing fat (cyst of zeis)
  • Removal of wart-like growth on eyelid (papillomas), skin tags or other lid lumps
  • Surgery for raised bump on the eyeball (pinguecula)
  • Surgery for sweat gland cysts containing clear fluid (cyst of moll).

Patient eligibility criteria:

The patient’s local NHS commissioning organisation will only fund upper and lower eyelid surgery if the patient meets the following eligibility criteria below:

  • Impairment of vision in a relaxed state, as determined by the visual field test reducing visual field to 120o laterally and/or more than 40o reduction vertically
  • Eyelid turned outwards from the eyeball (ectropion)
  • Eyelid folds into the eyeball (entropion) or for the removal of lesions of the eyelid skin or lid margin
  • Severe drooping of the upper eyelid from birth (congenital)
  • Eyelid turned outwards from the eyeball (ectropion)
  • Persistent firm round lump in the upper or lower eyelid (chalazion) caused by a chronic inflammation/blockage of the eyelid gland (meibomian gland) (only if alternative therapy has failed).

Chalazion - important note: Surgery is possible to remove the chalazion but in most cases surgery is not medically necessary because the cyst is harmless and will disappear with time, surgery does not prevent another cyst from developing, there is a one in five chance the cyst will regrow, there are rare but serious risks of surgery such as infection or scarring and for many children, it requires a general anaesthetic which carries a small risk to the general health.

Conservative therapy of a chalazion is defined as the following:

  • Most cysts disappear with time but can take weeks and sometimes many months, to go. They are normally harmless and can be safely left to get better with time in most cases.
  • Warm compresses might speed up the disappearance of the cyst. Use clean cotton wool or a clean flannel soaked in very warm water (be sure it’s not hot enough to burn). Squeeze out excess water and place the flannel or cotton wool on the patient’s closed eyelids over the cyst for two minutes at a time twice daily.

  • Occasionally, the doctor will prescribe a short course of antibiotic ointment or drops to help any irritation and, if there is infection spreading from the cyst, will prescribe antibiotics by mouth. However, medication does not cause the cysts to disappear.

Note: excessive skin in the lower lid may cause ‘eyebags’ but does not affect function of the eyelid or vision and therefore does not need correction. The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

Advice and further guidance:

  • For more information search for ‘eye lid problems’ at www.nhs.uk
  • Choosing Wisely UKis part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG

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