Among parts of the body, the eyelid is often one of the least-considered in terms of medical needs. Small in size and usually hidden during waking hours, the eyelid tends to be ignored – until it creates a problem or begins to look abnormal. The truth is that the eyelid serves a variety of important purposes, both in terms of ocular health and the ability to see clearly. The eyelid protects sensitive eyeballs from damage, disease and wear. Beyond that, without proper eyelid function, the eyeball’s ability to control focus would be nearly non-existent, making it nearly impossible to see clearly in bright rooms and outdoors.

A common concern regarding the health of the eyelid is the potential impact these small pieces of skin, tissue and muscle have on the outward appearance of the face. As mentioned, the eyelid is often forgotten about because it seems to disappear when the eye is open, but sagging, drooping eyelids are quite noticeable. If an eyelid swells or one eyelid does not open or close in tandem with the other, these often-ignored features suddenly become very pronounced. For these reasons and more, eyelid problems can lead some people to feel self-conscious and some people experience discomfort.

Treatment for Eyelid Disorders and Injuries

Most eyelid problems can be corrected through surgical means; however, prescription medications, cleansing solutions and topical ointments may be used to treat minor eyelid ailments, such as infections or swelling. Eyelid surgery can be completed using lasers and other advanced technology that allows a surgeon to target the smallest areas without damaging surrounding tissue, making these procedures appropriate for areas around the eye where sensitivity is high and complications can lead to sight issues. Most eyelid surgical procedures can be completed in a single visit, and recovery usually takes place at home with healing times varying based on the type of surgery and the extent of healing that needs to take place.

Does Medicare Cover Eyelid Surgery?

Caring for the health of the eyes becomes increasingly important with age as vision tends to naturally degrade over time. Eyelid problems exacerbate these issues. Because of this, many seniors may want or need eyelid surgery to correct drooping and sagging that is caused by the loss of skin elasticity with age.

Original Medicare benefits do not cover the cost of cosmetic surgical procedures, meaning Medicare recipients will have to pay for eyelid surgery on their own if the reason for wanting the procedure is to improve appearance. Medicare’s general rule is that it will provide coverage for medical care and treatment if services are deemed medically necessary by a Medicare-approved physician. In order for something to qualify as a medical necessity, Medicare tends to require that it be ordered by a licensed medical professional.

Eyelid Surgery Must Be a Medical Necessity

Medicare recipients may be able to gain coverage for eyelid surgery through Original Medicare if it can be demonstrated that the surgery is for a medical reason and is not cosmetic in nature. An example of a medical necessity may be where someone is experiencing sagging eyelids that are impairing vision to the point of near blindness. Another example may be where trauma has caused scar tissue to form inside the eyelid and recurring infection is occurring as a result of the eyelid no longer closing properly.

If eyelid surgery is ordered for a medical reason and the procedure happens to also improve a person’s appearance, there shouldn’t be a conflict with Medicare’s coverage. The key is that the procedure can not be based solely on a person’s desire to enhance his or her appearance in order to qualify. To learn more about your options, you should speak with your primary care physician if you feel that an eyelid problem is impacting your health.

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