As part of a project exploring service provision within oculoplastic surgery across the nation, I would be grateful if you could send me the following details on each of the procedures listed below:

Procedures: Blepharoplasty; ptosis repair; ectropion repair; entropion repair; brow lift; chalazion incision and curettage; benign skin lesion excision/surgical management; periocular botulinum toxin injections; adult strabismus surgery; lacrimal surgery procedures (including dacrocystorhinostomy, punctoplasty, punctal plugs); any others you believe fall under the remit of oculoplastic surgery that have not been listed.

Request 1

Are they routinely funded?

Response 1

Adult strabismus surgery and dacrocystorhinostomy are routinely funded.

Ectropion repair; entropion repair, punctoplasty and punctal plugs are NHS England services.

Request 2

If not routinely funded, how is this service accessed (eg criterion based access, individual funding request, other)

Response 2

Blepharoplasty and ptosis repair - Refer using criteria or IFR for exceptionality

Brow Lift including periocular Botulinum toxin injections - Refer through IFR for exceptionality

Chalazion incision and curettage - Refer using criteria or IFR for exceptionality

Benign skin lesion excision/surgical management - Refer using criteria or IFR for exceptionality

Request 3

If criterion based access, what are these criteria?

Response 3

Blepharoplasty and ptosis repair - Referral should only be made for the following indication:  To relieve symptoms of blepharospasm or significant dermatitis on the upper eyelid caused by redundant tissue or following skin grafting for eyelid reconstruction or following surgery for ptosis.  For all other individuals the following criteria apply:  Documented patient complaints of interference with vision or visual field related activities such as difficulty reading or driving due to upper eye lid skin drooping, looking through the eyelids or seeing the upper eye lid skin and there is redundant skin overhanging the upper eye lid margin and resting on the eyelashes when gazing straight ahead and evidence from visual field testing that eyelids impinge on visual fields reducing field to 120 degrees laterally and/or 20 degrees or less superiorly.

Brow Lift including periocular Botulinum toxin injections - Facelift procedures and Botulinum toxin will not be routinely commissioned by the NHS for cosmetic reasons.  Cases may be considered on an exceptional basis, for example in the presence of an anatomical abnormality or a pathological feature which significantly affects appearance.

Chalazion incision and curettage - Referral should only be made for the following indications:  Where conservative treatment has been tried for 3 months and has failed and where the meibomian cyst/chalazion is on the upper eyelid and interferes with vision or is causing persistent inflammation and pain.

Benign skin lesion excision/surgical management - The CCG will only offer funding if one or more of the eligibility criteria has been met.

• Diagnostic uncertainty exists and there is suspicion of malignancy. GPs are reminded to refer to the 7 features suspicious of malignancy as per NICE guidance on skin cancer.
• The lesion is painful or impairs function and warrants removal, but it would be unsafe to do so in primary care/community setting for example because of large size (>10mm), location (e.g. face or breast) or bleeding risk. Removal would not be purely cosmetic.
• Viral warts in the immunosuppressed
• Patient scores >20 in Dermatology Life Quality Index administered during a consultation with the GP or other healthcare professional.

Request 4

Were any ophthalmologists/optometrists consulted when creating the policy for the procedure? If so, please provide us with their name and role

Response 4

South Yorkshire and Bassetlaw have agreed a regional wide Commissioning for Outcomes Policy.