Alison Tendler MD Jason Schmit OD

Elective vs. Medical Eyelid Procedures LOOKING GREATSEEING GREAT

Dermatochalsis with Pseudoptosis

Ptosis

Brow Ptosis

Chief complaint Visual fields (Humphrey superior 36) Clinical presentation Documentation in chart Photos Dictation letter to insurance company or other preauthorization Peer-to-peer review Elective vs. Medical Determination

MEDICAL I have to raise my brows to see better I miss things to the top/sides I must tilt my chin up to see better Things feel heavy Chief Complaint ELECTIVE I don’t like how I look I can’t put make-up on easily Things feel heavy

Clinical measurements

Elective Medical HVF

Elective?Medical? Photos/Clinical Exam

Elective Medical Photos/Clinical Exam

Clinical experience Chief Complaint Measurements Photos Visual fields Sometimes it will still come down to clinical experience!!

Example #1

Example #2

Example #3

Example #4

Case #1 Lifting eyelids often to see better Lateral hooding and skin on lashes MRD: 1.5mm OU HVF: > 30% loss OU

Case #1

Case #2 OS eyelid droopy MRD: 2mm OD 1mm OS HVF: > 30% loss OS

Case #2

Case #3 Hard to see surroundings MRD: 0.5mm OD 1mm OS HVF: > 30% loss OU

Case #3

Case #4 Tired eyes/heavy eyelids Lateral hooding and skin resting on eyelashes MRD: 0.5mm OD 1mm OS VF: >30% loss

Case #4

Case #5 Heavy upper eyelids and hard to see surroundings. Lower lid puffiness Skin resting on lashes MRD: 3mm OD 2mm OD HVF: > 30% loss OU

Case #5

CAN BE MEDICAL CAN BE ELECTIVE Take home message Need to look at the entire periorbital area: Eyebrows Eyelid skin Eyelid muscles Lower lid areas BOTH medical and elective components

Thank You