Beyond visual field restriction: reconsidering functional assessment in upper eyelid dermatochalasis

Commonly, dermatochalasis is assessed mainly as a functional condition in which redundant upper-eyelid skin causes demonstrable visual field restriction. This narrative review examines if visual field assessment alone captures the full clinical burden of upper-eyelid dermatochalasis and the benefits of upper-eyelid blepharoplasty.

A narrative review was undertaken using PubMed/MEDLINE, Google Scholar and citation searching. All primary studies included in the review that reported symptoms, patient-reported outcomes, anatomical severity or postoperative functional outcomes were extracted into structured evidence tables. Reviews, policy documents and referral guidelines were synthesized narratively.

Evidence supports improvement in the superior visual field after upper-eyelid blepharoplasty. Other reported benefits include improved contrast sensitivity, headache-related quality of life, eyelid heaviness, tearing and patient-reported visual quality of life, lid-margin position, redundant-skin severity, lateral hooding or aesthetic outcome. No single validated dermatochalasis-specific functional symptom questionnaire is currently available that captures the full burden, and anatomical severity does not consistently predict patient-reported benefit. The current UK National Health Service (NHS) eligibility criteria are commonly centered on visual field loss, eyelid positioning or pupil occlusion. The Danish criteria provide a comparator by combining symptom burden with anatomical findings.

Visual field restriction is an important indication for publicly funded upper-eyelid blepharoplasty, but it is not a complete measure of disease burden. Future referral criteria should consider the addition of a structured dermatochalasis symptom score.