Insurance Coverage for Double Eyelid Surgery?

I wear contact lenses about two years ago. Then due to a heavy college workload I would wear them for extended periods of time (from about 7AM to 12AM). Suddenly I began to get horrible eye infections and when I went to see an eye doctor he told me that I had scarring on the edge of my cornea and recommended that I stop wearing contacts.

However, I am near-sighted in one eye and far-sighted in the other and wearing glasses for longer than 2-3 hours causes horrible migraines. I've gone to the ER countless times due to the severity of my migraines. When I returned for a follow up, the eye doctor stated that the reason I was so infection-prone was because my eyelids were very tight in the inner corners, causing my eyelashes to rub against my eyes, and when combined with the contacts, led to infection.

My eye doctor then recommended that when I turned 20 (which I am now), I should ask him to re-examine my eyes and he would refer me to a plastic surgeon for a double eyelid surgery. He stated that due to the nature of my condition, it was likely that my insurance would cover the costs. Do insurance companies commonly do this? I know I have excellent coverage so would this make a difference.

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5 Doctor Answers | Asked by lilywang2009 in Troy, MI, U.S

Doctor Answers (5)
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Insurance may cover eyelid surgery, but you may have to pay up front

Scarring of the interior lamella or the area of the lids closest to the globe can cause the eyelashes to turn toward the globe, causing irritation. Usually, this causes chronic irritation that feels like there's something in your eye. It's doubtful that this is causing the infections. More likely, it's the contacts. Either way you need to see an oculoplastic surgeon. These surgeons are ophthalmologists who specialize in ways to correct your problem. Many of these surgeons expect... more

You may get coverage for the functional, not cosmetic reasons.

My best advice would be to go to an academic practice that is used to doing reconstructive procedures and dealing with insurance companies. If the insurance is going to cover the surgery, it would be for the functional/anatomic reasons, not for any cosmetic concerns.

Insurance will cover functional eyelid surgery

After reading your story, it appears that you may have one or more medical conditions that can be corrected with eyelid surgery. As you already know, no insurance company will pay for cosmetic eyelid surgery. However, it sounds like you have entropion, a condition in which the lower eyelid margins are inverted, causing the lashes to rub against and irritate the cornea, which is known as trichiasis. Your history of mulitple infections and corneal irritations supports this. Your... more

Cosmetic double fold surgery is not covered but functional surgery should be

Dear Lily, The condition you are describing is upper eyelid entropion. It is a situation where there is poor support for the upper eyelid platform skin, allowing the skin and the underlying muscle to ride down toward the edge of the upper eyelid. This causes the lid margin and the eyelashes to rotate toward the eye and rub. Addressing this is a medical not a cosmetic issue. Having said that you also need an anesthetically well done surgery which means respecting the your asian eyelid... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Most likely covered by medical insurance.

If the excess skin and/or lashes are causing irritation of the eyelid, this is usually a medical condition and covered under the patient’s medical insurance.