Eyelid Surgery for Thyroid Eye Disease

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Through BOPSS, Rebecca Ford and her team completed a UK survey on the provision of eyelid surgery for patients with thyroid eye disease (TED). The conclusions were presented at the 2019 BOPSS meeting.

Provision for this surgery varies depending on the individual CCGs. Before approval is obtained for eyelid surgery, however, most patients will have had to apply for individual funding requirements (IFR), secured prior approval (PA) or met the criteria for a planned procedure with a threshold (PPPwT).

These approvals are usually based on how much the peripheral vision is affected or vision obstructed (in cases of droopy lids or excess skin), or on how dry is the eye (in cases of lid retraction). Only around 2% of CCGs state specifically in their lid-surgery policies that they exempt patients with TED from their eligibility criteria.

No CCGs fund eyelid surgery purely for cosmetic reasons, and most are strict about requiring reasons for surgery over and above appearance-related concerns. However, some may give consideration to surgical rehabilitation of TED if change in appearance due to the condition is affecting mental health.

Overall, all we can advise at present is that patients continue to ask for surgical rehabilitation, if desired, and that GPs state on the CCG funding requests both how the eyelid appearance is affecting the patient’s life and that the problem is due to TED. Continuous collection of quality of life measurements, as well as premorbid photographs, may also help support an individual’s case for eligibility.

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