When is eyelid surgery medically necessary?

December 19, 2014 Matthew J. Hauck

close up of a senior woman's closed eye


In this article:

  • Eyelid surgery is not always cosmetic — it is often performed to help patients see. 

  • Signs of medical necessity include patients’ reported symptoms as well as objective measurements.

  • Ophthalmologists at Swedish can help you determine if surgery is medically necessary.

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 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 about how to know when such surgeries are medically necessary.

The most important factor in determining the medical necessity of eyelid surgery is based on subjective findings, i.e. 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. 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 (eyelid drooping) impairing reading or other close work activities
  • Chin-up head tilt to read or see better
  • Symptoms of eye strain or discomfort
  • Central visual interference due to upper eyelid position
  • Patient self-reported functional impairment

Keep in mind that 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. 

Find a doctor

If you have questions about eyelid surgery, contact eye surgery services at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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