An 89 year old woman presented to me with her eyelids turning out. She had trouble seeing, with constant irritation, and tearing. She underwent a retractor reinseration in my office under local injection alone and the second photo was taken 10 minutes after the procedure. This is done by first injecting a numbing medication and they suturing stiches to stabilize the eyelid back into the normal position.
The question that is asked is when is a patient too old for oculoplastic surgery? When most people think of eyelid surgery, they think of cosmetic eyelifts or eyebag removal. They do not think of functional surgery. Functional surgery is surgery that is performed to improved the daily functions or suffering of the patient. It is done for medical reasons and not cosmetic one. Yes, most often functional surgery does give a patient a cosmetic improvement as a side detail. No one would question that the patient in the second photo looks much more "normal". Her family and herself were happy with the cosmetic improvement but more importantly they were pleased with the functional improvement. The answer to this question is that any patient can recieve oculoplastic surgery for a functional problem if a. the benefits of the surgery outweigh the risks b. there is a significant disability from the condition and c. the patient is healthy enough for the procedure.
The risks versus benefits of surgery are dependant on understanding the benefits for each particular patient and the risks for that individual patient. Risks include whether the surgery will work, does the patients anatomy have particular risks for complications or whether it is worth it for a patient to take on the risks of the surgery at all.
The disability of the condition that a patient has can only really be answered by the patient. Of course if someone has a small excess amount of upper eyelid skin and claims it is ruining their life though it does not hang over the lashes or causes a functional problem, the insurance company may decide not to pay for it. In general however, a functional problem that creates disability is covered by insurance companies including medicare. As an eyelid surgeon in Denver I commonly deal with this issue when it comes to blepharoplasty however, it is possible for this to be an issue for any eyelid problem. As an oculoplastic surgeon I can help guide patients as to whether it is likely or not whether insurance will pay for surgery.
The patient's health is finally evaluted by their primary care doctor to see if they can handle the surgery. Are they on blood thinners that can't be stopped? Are they so sick that they may not live much longer and the surgery may just cause their remaining time on earth to be miserable? These are the questions that a primary care doctor can do to answer this question with the patient.
Putting all this information together, allows patients to decide to have surgery regardless of age. I have performed surgery on patients over the age of 95 and under 1 year. There have been 65 year old patients who are not candidates for surgery along with 89 year old patients such as this one who are candidates. It is a tough decision but one your team of doctors can help you decide.