Surgery on the upper eyelid (upper lid blepharoplasty) and browlifts

Prior approval – to ensure the best outcomes, patients must have stopped smoking at least 4 weeks prior to referral.

This procedure will be funded to correct functional impairment as demonstrated by:

• Impairment of visual fields in the relaxed, non-compensated state. Objective evidence of this will be required and must be documented
• Clinical observation of poor eyelid function, discomfort e.g. headache worsening towards the end of the day and / or evidence of chronic compensation through elevation of the brow

Further advice:

Many people acquire excess skin in the upper eyelids and brow 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 apparatus then this can warrant treatment

Visual Field Tests must be performed and documented by the treating clinical team as follows:

1. 1. Group 1 Drivers/non-drivers:

• A field of at least 120° on the horizontal measured using a target equivalent to the white Goldmann III4e settings. Where the Ophthalmology service does not have access to the white Goldmann III4e, the ICB will accept clinical judgement in determining the most appropriate visual field assessment for each individual patient
• The extension should be at least 50° left and right. In addition, there should be no significant defect in the binocular field that encroaches within 20° of the fixation above or below the horizontal meridian

2. Group 2 (bus and lorry) Drivers:

• An uninterrupted measurement of at least 160° on the horizontal plane
• Extensions of at least 70° left and at least 70° right
• Extensions of at least 30° above and at least 30° below the horizontal plane
• No significant defect within 70° right and 70° left between 30° up and 30° down ( it would be acceptable to have a total of up to 3 missed points, which may or may not be contiguous*)
• No defect is present within a radius of the central 30°

References:

https://baaps.org.uk/patients/procedures/9/eyelid_surgery_blepharoplasty

https://bapras.org.uk/docs/default-source/commissioning-and-policy/information-for-commissioners-of-plastic-surgery-services.pdf?sfvrsn=ba572cc3_2

https://www.gov.uk/guidance/visual-disorders-assessing-fitness-to-drive#minimum-standards-for-field-of-vision–all-drivers

Surgery on the lower eyelid (lower lid blepharoplasty)

Prior approval – to ensure the best outcomes, patients must have stopped smoking at least 4 weeks prior to referral

This procedure will be funded for correction of ectropion or entropion or for the removal of lesions of the eyelid skin or lid margin

References

https://baaps.org.uk/patients/procedures/9/eyelid_surgery_blepharoplasty

https://bapras.org.uk/docs/default-source/commissioning-and-policy/information-for commissioners-of-plastic-surgery-services.pdf?sfvrsn=ba572cc3_2