eyelid surgery

[oldie]

can droopy eyelids become an eye health and sight problem  and not just a cosmetic nuisance?
Some sources call it elective and cosmetic, others blepharoplasty and thus needing attention.
can you clear my confusion.please.

[Doreen Fazio, M.D.]

I agree completely with flossy93.  While overhanging lid skin (dermatochalasis) or drooping upper lids (ptosis) do not harm the eye health of adults, they can interfere with vision and functioning.  I would recommend that you see an ophthalmologist who specializes in oculoplastic surgery.  You may be able to get a recommendation from the ophthalmologist who did your cataract surgeries, or from the ASOPRS American Society of Plastic and Reconstructive Surgeons) web site.

[flossy93]

If you've made it this far there's no reason to think you won't continue to roll along!  But losing visual field area isn't principally a cosmetic matter - not being able to see correctly is a medical problem.   If you become more handsome in the process that's just gravy.  :-)

Just be sure you have any upper field obstruction evaluated before you lose so much of your visual field area that you start banging your head into tree branches, upper cabinet doors, etc.  It can happen.

Sometimes only the upper eyelid surgery is needed to restore a normal visual field.  At other times a forehead lift is done concurrently to move sagging eyebrows back to their normal position, and give the surgeon enough 'real estate' in the upper eyelid area to restore the patient's field of vision.  

A doctor can evaluate any obstruction in your visual field and let you know whether you would qualify for a medically necessary procedure, and if so what they recommend to fix any issues.  Good luck!

[oldie]

thank you for that comprehensive reply. One point about my case is that I'm 85 and that's no age to be thinking about getting handsomewith an eye lift.However a doc says it could get worse before I hit 90 so maybe I'll go ahead. I had catarcts done two months ago.

[flossy93]

Yes, drooping eyelids that interfere with vision can become a health problem.  When they interfere sufficiently with the patient's vision to affect overall health and safety, a 'functional blepharoplasty' is needed to restore normal sight lines and vision.

Your confusion is understandable.  Whether it's elective surgery or medically necessary depends on how much the drooping tissue interferes with the patient's vision.  There are specific criteria that determine whether a surgery is medically necessary to restore a normal visual field; these criteria vary a bit on the Medicare or other provider doing the evaluation.  But they are all similar, or should be.

Drooping eyelids that restrict the upper half of the visual field or subject the patient to extensive muscle strain in the forehead to constantly 'lift' the eyelid tissue out of the way, resulting in chronic headache, are examples of when a surgery to correct the problem might be deemed medically necessary.