TNRF2: Ophthalmology

Overview

A chalazion is a red, tender lump in the eyelid. It is also known as a stye.

The swelling occurs because one of the oil glands that is next to each eyelash can get backed up and become inflamed.

Small chalazia can be removed by making an incision on the inside of the eyelid; large chalazion can be removed by making an incision on the front of the eyelid and close it with dissolvable stitches.

Thresholds and eligibility 

This procedure is not routinely funded. 

Chalazia (meibomian cysts) are benign, granulomatous lesions that will normally resolve. Treatment consists of regular (four times daily) application of heat packs. 

NHS Surrey Heartlands will fund excision of chalazia when the following criteria are met: 

• Chalazion will be removed when it has been present for a minimum of 4 months.

AND 

• When it is causing blurred vision.

OR 

• When it is a source of regular infection that has required medical attention twice or more.

The watchful waiting period should usually be between four to six months at the clinician's discretion as many will resolve with conservative management during that time. 

In common with all types of lesions, NHS Surrey Heartlands will fund removal where malignancy is suspected. 

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids.

Thresholds and eligibility 

Blepharoplasty will not be funded for cosmetic reasons.

NHS Surrey Heartlands will consider funding in the following circumstances:

Upper blepharoplasty

• There is documented evidence of interference with vision (such as difficulty reading, driving, looking through the eyelids or seeing the upper eyelid skin).

OR

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

OR

• There is evidence that where it is not overhanging, the upper lid covers the upper pupil margin.

AND

• Evidence from visual field testing shows the visual fields are reduced to 120 degrees laterally and/or 20 degrees or less superiorly.
  • A degree of interpretation will need to be applied as the area of the visual field where the missing points are concentrated within the 120 to 20 range is crucial to establish the severity of the visual impairment. 

AND

• Photographic evidence is provided and must show the redundant skin overhanging the upper eyelid margin and resting on the upper eyelashes when gazing straight ahead. Photographs must be taken:
  • from the front with the camera at eye level with the lid in a relaxed position and the person looking ahead.
  • the above will need to be supplemented by a picture taken from the side of the patient.
    • Note: It is recommended that the test is monocular and that the 120-point Humphrey visual field chart is used.

Lower blepharoplasty

• Correction of Ectropion or Entropion which threatens the health of the affected eye.

OR

• Removal of lesions of eyelid skin or lid margin causing functional problems.

OR

• Rehabilitative surgery for patients with thyroid eye disease.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

Cataract surgery involves replacing the cloudy lens inside your eye with an artificial one. It has a high success rate in improving your eyesight.

Thresholds and eligibility 

Cataract removal in adults

This policy applies to people aged 18 or over.

Any referral for first or second eye cataract surgery must include how visual symptoms, experienced as a result of cataract/s, are negatively affecting the patient’s lifestyle.

Base the decision to refer a person with a cataract for surgery on a discussion with them that includes:

• How the cataract affects the person’s vision and quality of life
• Whether one or both eyes are affected
• What cataract surgery involves, including possible risks and benefits
• How the person’s quality of life may be affected if they choose not to have cataract surgery
• Whether the person wants to have cataract surgery

Do not restrict access to cataract surgery on the basis of visual acuity

The Surrey Priority Committee advises that:

• the risks and benefits are fully discussed with the patient prior to surgery. Give people with cataracts, and their family members or carers (as appropriate), both oral and written information. Information should be tailored to the person’s needs, for example, in accessible format
• bilateral cataract extraction may be considered where clinically appropriate, and in accordance with NICE guidance (NG77 1.6 Surgical timing and technique).

Patients should be encouraged to stop smoking, if appropriate, prior to surgery.

Exceptional circumstances may be considered where there is evidence of significant health impairment and there is also evidence of the intervention improving health status.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.