Eyelid surgery (frequently referred to as blepharoplasty) is a very common procedure performed for drooping upper eyelids.
While the surgery is often performed in order to restore a more youthful appearance, there are many situations in which eyelid surgery is medically necessary to improve vision or function.
The condition of drooping upper eyelids can occur as a result of several different diagnoses, which may be treated differently. The most common diagnoses are dermatochalasis (excess eyelid skin), and blepharoptosis (downward displacement of the eyelid margin).
Blepharoplasty is a surgery to remove excess skin (and sometimes muscle or fat) from the upper or lower eyelids. This is different from blepharoptosis surgery, which usually involves tightening of the muscles that elevate the eyelid.
Regardless of the cause of one’s drooping eyelids, the common question I receive from colleagues, family, and patients is:
When is Eyelid Surgery Medically Necessary?
The most important factor in determining the medical necessity of eyelid surgery is based on subjective findings, or the patient’s symptoms. Typically a patient will already know if their eyelids are causing problems with their activities of daily living, such as trouble reading, driving, or causing eye strain or headache.
In addition to subjective findings, there are also objective findings that the treating physician typically records, such as eyelid measurements, photographs, and visual field testing.
According to this article reported by the American Academy of Ophthalmology, functional indications for blepharoplasty and blepharoptosis include:
- Margin reflex distance 1 (the distance between the edge of the eyelid and the center of the pupil) of 2mm or less
- Superior visual field loss of at least 12 degrees or 24%
- Down-gaze ptosis impairing reading or other close work activities
- Chin-up head tilt
- Symptoms of eye strain or discomfort
- Central visual interference due to upper eyelid position
- Patient self-reported functional impairment
Keep in mind, these are suggested guidelines, not rules. The final outcome for functional surgical coverage is up to the patient’s individual insurance company. Many have their own guidelines, which are separate from these recommendations.
When Should You See a Doctor?
Drooping upper eyelids can cause significant functional and/or cosmetic problems. If you feel like your eyelids are affecting your daily life, you may be a good candidate for this elective procedure. You can learn more by calling our office at 425-216-7200, and make sure to check out some before/after photos here.