Policy number: SRP 075
Policy name: Oculoplastic Procedures
Status: Group Prior Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Oculoplastic procedures are mostly for cosmetic reasons and are not commissioned. However, there are a number of conditions which affect vision and functionality affecting activities of daily living and quality of life for which such procedures may be considered if criteria met.
To note that for diagnostic uncertainty or suspicious symptoms patients should be referred under the 2 weeks wait, and this commissioning policy does not apply.
This policy covers adults and children.
The following eyelid surgery procedures will NOT be commissioned:
- Removal of eyelid papilloma or skin tags
- Excision of other peri-orbital or lid lumps
- Surgery for cosmetic reasons
Surgical treatment is commissioned if one or more applies:
- Excess tissue or drooping (ptosis) of the upper eyelid causing functional visual impairment.
- To repair defects predisposing to corneal or conjunctival irritation
- Periorbital sequelae of thyroid disease or nerve palsy or trauma
- Prosthesis problems in an anophthalmia socket
- Painful symptoms of blepharospasm resistant to conservative management
- Following skin grafting for eyelid reconstruction.
The following conditions are NOT routinely commissioned unless specific criteria are met:
Ectropion/Entropion
Typically, a consequence of advanced age, in which the eyelid is turned outwards away from the eyeball or inwards toward the eyeball.
- Conservative management has been exhausted.
- Evidence of significant impairment of the punctum
- There is recurrent infection in surrounding skin.
Epiphora
Overflow of tears onto the face- a clinical sign or condition that constitutes insufficient tear film drainage from the eyes in that tears will drain down the face rather than through the nasolacrimal system.
- Despite undergoing conservative management, the patient is experiencing a daily impact of significant watering of the eyes indoors and outdoors.
- Impairment of visual function and interfering markedly quality of life.
Chalazion/Meibomian cyst
Chalazia are benign, granulomatous lesions caused by blockage of the Meibomian gland duct, which will normally resolve within 6 months with conservative management in primary care. They can be unsightly and, if large enough, obscure vision. In rare cases, they can lead to conjunctivitis or cellulitis. Conservative treatment is the regular i.e. three or four times a day application of hot compression to the cyst (e.g. hot wet flannel) to encourage it to spontaneously drain.
When chalazia are treated with conservative treatment for one month, rates of resolution are around 50%. Further conservative treatment may increase rates of resolution but, where conservative treatment fails, patients may be treated with surgery or steroid injections, which give high rates of resolution (80-90%).
Incision and curettage (or triamcinolone injection for suitable candidates) of chalazia should only be undertaken if at least one of the following criteria have been met:
- Has been present for more than 6 months and has been managed conservatively with warm compresses, lid cleaning and massage for 4 weeks.
- Interferes significantly with vision.
- Interferes with the protection of the eye by the eyelid due to altered lid closure or lid anatomy.
- Is a source of infection that has required medical attention twice or more within a six-month time frame?
- Is a source of infection causing an abscess which requires drainage?
- If malignancy (cancer) is suspected e.g. Madarosis/recurrence/other suspicious features in which case the lesion should be removed and sent for histology as for all suspicious lesions
Patients meeting the above criteria may be treated in community (Tier2) services where commissioned.
Patients meeting the following criteria should be referred to oculoplastic surgeons:
- All children should be referred.
- Any recurrent chalazion should be referred.
- Any atypical features i.e. lash loss, bleeding should be referred.
- Any patient with previous history of Basal cell carcinoma (BCC) or Squamous cell carcinoma (SCC) or where malignancy is suspected should be referred.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances
This replaces SRPs for Chalazion and Blepharoplasty,