Eyelid expert testimony from a board certified ophthalmologist is useful in a variety of situations. An ophthalmologist is often utilized to help determine the rationale for medical necessity regarding eyelid surgery and provide explanations for complications that can result from eyelid surgery.
Medical Necessity
Surgery of the upper eyelids may be indicated when either the skin or muscle of the upper eyelid droops to a sufficient degree as to cause significant loss of vision. Tissue that drapes across the eye may block the visual field of an individual. A sufficient degree of blockage may impair the ability to see objects up above such as traffic lights and road signs. A non-invasive test known as a visual field examination can determine the presence and degree of vision impairment from obstruction by upper eyelid tissue.
Medical necessity for eyelid surgery also applies when it is performed to address significant malpositions, injuries, and reconstruction following removal of lesions such as tumors of the eyelid. Eyelid expert testimony may help distinguish eyelid surgery performed for functional or cosmetic reasons.
When surgery of the lids is performed to simply remove an extra roll of skin or eliminate a few wrinkles, the primary purpose is deemed cosmetic in nature. However, standards of care regarding the application of proper surgical principles apply to eyelid surgery performed for either cosmetic or functional reasons. Commonly eyelid surgery performed for functional reasons also results in cosmetic improvement.
Anesthesia
In most cases of eyelid surgery, local anesthesia is sufficient. Local anesthesia may be applied by a trained ophthalmologist or anesthesiologist. Most local anesthetics are quick-acting and sufficient to minimize discomfort. Systemic sedation may be considered on an individual basis, particularly for patients who are apprehensive or have health issues. Systemic sedation is usually administered intravenously by an anesthesiologist in an outpatient surgical facility. Eyelid expert testimony is limited primarily to issues of anesthesia administered by the operating surgeon.
Blepharoplasty
Eyelid surgery to remove excessive tissue, reposition a droopy eyelid, or remove excessive fat from either the upper eyelid or lower eyelid is generally referred to as blepharoplasty. Surgery to elevate a droopy eyelid is generally referred to as ptosis repair. Eyelid expert testimony may be utilized to analyze the appropriateness of a procedure to address a specific diagnosis.
Preoperative patient evaluation
An evaluation of a candidate includes a through medical history and list of medications. Medications that have blood-thinning effects need to be considered carefully prior to eyelid surgery. Depending on individual circumstances, many surgeons recommend that aspirin be discontinued at least ten days prior to surgery to avoid bleeding. Many blood thinners may be resumed shortly after eyelid surgery.
A preoperative evaluation usually includes measurement of visual acuity and general testing of the eye to rule-out any significant underlying abnormalities. Good communication between the physician and patient is helpful in discussing reasonable expections, potential benefits, risks and possible complications.
Risks and complications
Virtually any surgery has potential risks and possible complications. The process of informed consent addresses these issues and are typically documented in the medical record. The risks, benefits, and alternatives to surgery are generally discussed with patients prior to surgery. The potential complications from eyelid surgery range from those that are benign and temporary such are mild blurriness or bruising that clears within a short time, to more serious complications that includes an adverse reaction to anesthesia or even blindness. Blindness as a devastating complication from eyelid surgery is exceedingly rare and has a greater association with fat removal of the lower eyelids. A variety of different types of complications from eyelid surgery can result in dry eyes but these are usually mild and transient.
Evaluation of medical records including operative reports are usually provided to a qualified ophthalmologist for eyelid expert testimony. A clear and thorough understanding of eyelid surgery is needed for an objective medical assessment with the primary goal of patient safety and satisfaction.
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