Please see below for the policies relating to eyes. To view the policy, patient leaflet and additional information, please click on the relevant heading.

What is eye surgery for cataracts?

A cataract exists when the lens of an eye becomes cloudy and may affect vision. Cataracts most commonly occur in older people and develop gradually.

Cataracts can usually be treated with a routine day case operation where the cloudy lens is removed and is replaced with an artificial plastic lens (an intraocular implant). Cataract eye surgery is a relatively straightforward procedure that usually takes 30 to 45 minutes.

It’s often carried out as day surgery under local anaesthetic, which means the patient will be awake during the procedure and can go home on the same day. During the operation, the surgeon will make a tiny cut (incision) in the patients eye so the affected lens can be removed. After it’s been removed, a small plastic lens will be inserted.

If the patient has cataracts in both eyes, the patient will have two separate operations. This gives the first eye time to heal and time for the patients vision to return.

Patient eligibility criteria:

Eye surgery for cataracts is restricted. This means the patient's local Clinical Commissioning Group will fund the treatment if the patient meets the stated clinical threshold for care.

If the clinical threshold is not met, the clinician in charge of the care of the patient’s specific condition, usually a hospital doctor or optometrist can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

The patient’s lifestyle is affected by disabling visual symptoms attributable to cataracts such as:

  • Difficulty carrying out everyday tasks such as recognising faces, watching TV, cooking
  • Playing sport and driving; reduced mobility, unable to drive or experiencing
  • Difficulty with steps or uneven ground and the ability to work, give care or live independently is affected.

This information, together with a report from a recent sight test, should form the minimum data required to be referred for surgery.

Other indications for cataract surgery include treatment for one or more of the following:

  • Monitoring disease of the area behind the lens of the eye (posterior segment disease)
  • Correcting lazy eye (anisometropia)
  • Patients with glaucoma who require cataracts surgery to control fluid pressure in the eye.

This is because although clarity of vision remains a useful component of the assessment of visual disability from cataract, cataract surgery should be considered in the first eye or second eye of a patient who has disabling visual symptoms attributable to cataract. For instance, a patient who experiences disabling glare due to cataract when driving may still achieve clarity of vision (6/9) under ideal light conditions.

This recommendation is consistent with advice from the Royal College of Ophthalmologists, and where implemented in local commissioning guidance has been found to be practical and equitable.

Patients with single sight (monocular vision):

The indications for cataract surgery in patients with single sight, where vision in which both eyes are used separately (monocular vision) and those with severe reduction in one eye, are the same as for patients with binocular vision.

Advice and further guidance:

At first the patient's optometrist may be able to prescribe new glasses that will help with changes to the patient’s vision caused by the cataract. When this no longer helps the patient to see well enough, the only effective treatment is surgery.

You can read the 'cataracts decision aid'. See separate leaflet for more information on Individual Funding Requests (IFRs).

  • For more information search for ‘cataract surgery’ at www.nhs.uk

What is eyelid surgery?

Eyelid surgery (or blepharoplasty) is a surgical procedure performed to correct puffy bags below the eyes and droopy upper eyelids. It can improve appearance and widen the field of peripheral vision.

Many people acquire excess skin in the upper eyelids as part of the process of ageing and this may be considered normal. However, if this starts to interfere with vision or function of the eyelid then this can warrant treatment. This procedure will be funded by the NHS to correct functional impairment but the following eye lid procedures will not be funded:

  • Surgery for cosmetic reasons
  • Surgery for yellowish cysts containing fat (cyst of zeis)
  • Removal of wart-like growth on eyelid (papillomas), skin tags or other lid lumps
  • Surgery for raised bump on the eyeball (pinguecula)
  • Surgery for sweat gland cysts containing clear fluid (cyst of moll).

Patient eligibility criteria:

The patient’s local NHS commissioning organisation will only fund upper and lower eyelid surgery if the patient meets the following eligibility criteria below:

  • Impairment of vision in a relaxed state, as determined by the visual field test reducing visual field to 120o laterally and/or more than 40o reduction vertically
  • Eyelid turned outwards from the eyeball (ectropion)
  • Eyelid folds into the eyeball (entropion) or for the removal of lesions of the eyelid skin or lid margin
  • Severe drooping of the upper eyelid from birth (congenital)
  • Eyelid turned outwards from the eyeball (ectropion)
  • Persistent firm round lump in the upper or lower eyelid (chalazion) caused by a chronic inflammation/blockage of the eyelid gland (meibomian gland) (only if alternative therapy has failed).

Chalazion - important note: Surgery is possible to remove the chalazion but in most cases surgery is not medically necessary because the cyst is harmless and will disappear with time, surgery does not prevent another cyst from developing, there is a one in five chance the cyst will regrow, there are rare but serious risks of surgery such as infection or scarring and for many children, it requires a general anaesthetic which carries a small risk to the general health.

Conservative therapy of a chalazion is defined as the following:

  • Most cysts disappear with time but can take weeks and sometimes many months, to go. They are normally harmless and can be safely left to get better with time in most cases.
  • Warm compresses might speed up the disappearance of the cyst. Use clean cotton wool or a clean flannel soaked in very warm water (be sure it’s not hot enough to burn). Squeeze out excess water and place the flannel or cotton wool on the patient’s closed eyelids over the cyst for two minutes at a time twice daily.
  • Occasionally, the doctor will prescribe a short course of antibiotic ointment or drops to help any irritation and, if there is infection spreading from the cyst, will prescribe antibiotics by mouth. However, medication does not cause the cysts to disappear.

Note: excessive skin in the lower lid may cause ‘eyebags’ but does not affect function of the eyelid or vision and therefore does not need correction. The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

Advice and further guidance:

  • For more information search for ‘eye lid problems’ at www.nhs.uk
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.