Threshold

Norfolk and Waveney CCGs will fund removal of redundant skin of eyelids on a restricted basis for patients who meet the following criteria:

UPPER LID

• Documented patient complaints of interference with vision or visual field related activities such as difficulty reading or driving due to upper eyelid skin drooping, looking through the eyelids or seeing the upper eyelid skin

AND

• There is redundant skin overhanging the upper eyelid margin and resting on the eyelashes when gazing straight ahead

AND

• A visual field test by the hospital shows that eyelids impinge on visual fields reducing field to either 120° laterally and or by 40° vertically in the relaxed, non-compensated state.
• Fields should be assessed with the lid in its normal position and again with the lid taped up in order to demonstrate that it is the droopy lid causing the field defect.

Exemptions - Removal of redundant skin of upper eyelids is considered medically necessary for the following indications:

• To repair defects predisposing to corneal or conjunctival irritation such as entropion or pseudotrichiasis.
• To treat periorbital sequelae of thyroid disease, nerve palsy, blepharochalasis, floppy eyelid syndrome and chronic inflammatory skin conditions.
• To relieve symptoms of blepharospasm or significant dermatitis on the upper eyelid caused by redundant tissue.
• Following skin grafting for eyelid reconstruction.

LOWER LID

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

For patients not meeting the above criteria, an application should be made to the IFR Panel if the referrer considers there are clinically exceptional circumstances.