1. Alison Tendler MD Jason Schmit OD

2. Elective vs. Medical Eyelid Procedures LOOKING GREATSEEING GREAT

3. Dermatochalsis with Pseudoptosis

4. Ptosis

5. Brow Ptosis

7. 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

8. 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

9. Clinical measurements

10. Elective Medical HVF

11. Elective?Medical? Photos/Clinical Exam

12. Elective Medical Photos/Clinical Exam

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

15. Example #1

17. Example #2

19. Example #3

21. Example #4

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

27. Case #1

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

30. Case #2

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

33. Case #3

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

36. Case #4

37. 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

39. Case #5

41. 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

42. Thank You