Does health insurance pay for a ptosis operation?

When the finding is functionally relevant. The most common and clearest evidence for that is a restriction of the upper visual field that demonstrably improves when the lid is raised — the correction is then a medical service and goes through basic health insurance. There are also further functional reasons that can likewise count as treatment of an illness: a lid margin that reaches down over the pupil, a head position with a raised chin forced by it, or in a child the risk of weak sight. Demonstrating that is done with a standardised visual field measurement, once in the starting state and once with the lid held up, together with eyelid measurements and photographic documentation. We submit these documents before the procedure as an application for cost approval; the decision is made by your insurer, not by us. If there is no functional restriction, the correction is an aesthetic service and therefore self-pay; in the medical case the deductible and co-payment apply as with any other procedure.

What is the difference between a ptosis and a hooded eyelid?

The place where the problem sits. With a hooded eyelid there is too much skin over the lid crease, while the lid margin itself sits where it belongs — what is removed is therefore skin. With a ptosis the amount of skin is not the issue: the lid margin itself sits too low, because the lid-lifting muscle or its fine tendon at the lid has lost power or its attachment — what is dealt with is therefore the lid-lifting muscle. A rough self-check helps to tell them apart: lift the fold of skin slightly, close above the lashes, without moving the brow. If the view opens up immediately, it is about skin. If the lid margin stays low over the iris, it is about the lid-lifting muscle. Both can be present at once, and then both have to be dealt with — otherwise the result is technically faultless and disappointing all the same.

Can a drooping upper lid get better on its own?

That depends entirely on the cause, and that is why the cause is established first. A lid that sits lower after eye surgery, after marked swelling or after an injury often recovers over weeks to months. A lid that droops as part of a nerve palsy can likewise recover — which is why in such cases the course is awaited and surgery follows only once the finding has been stable for months. If the lid height varies over the course of the day, a disorder of the transmission of signals between nerve and muscle is in question; what is then treated is that disorder and not the lid. What does not resolve on its own is the commonest form in adulthood: a lid-lifting tendon that has loosened over years. It stays, and slowly increases.

My upper lid has been drooping since my cataract operation — is that normal?

It happens, and it is usually temporary. The lid speculum, the anaesthetic, swelling and the handling of the lid can change the lid height for a few weeks; in most cases the lid finds its old position again. If it is still sitting lower after about three to six months, a loosened lid-lifting tendon is often behind it — a predisposition that was already there beforehand and that the procedure has made visible. That is readily correctable, but not something to go on waiting over. Have it measured; nothing more than an examination is needed for that to begin with.

Will both eyes sit at the same height after the operation?

The aim is a lid height that opens up the view and looks right in the face — nobody can promise you exact symmetry in good faith. No face is symmetrical, and lid height responds in the range of millimetres. On top of that comes an effect that surprises many people: if both lids droop to different degrees and only the lower one is raised, the other can sink somewhat afterwards — the brain drives the two lid-lifting muscles together, and the extra drive for the poorer lid falls away. We check for that before the procedure by raising the lower lid experimentally and watching the other side, and we plan accordingly. A corrective procedure is possible and is needed in some cases; that belongs said beforehand and not afterwards.

Is there an alternative to an operation — tapes, creams, a pair of glasses?

Creams, serums and massage devices do not raise any lid margin; they do not even reach the muscle that is at issue. Lid tapes and adhesive strips lift the lid crease mechanically for a few hours — they pull on very thin skin, are better suited to an occasion than to everyday use, and with frequent use they irritate the skin of the lid. There is one genuine, rare alternative: a lid support fixed to the spectacle frame that raises the upper lid mechanically. It is used where surgery is not to be done, or not yet permitted — while a nerve palsy is recovering, for instance, or with a muscle disease that is progressing. It does not remove the cause, but it bridges the gap. Whether that makes sense in your case we say after the examination.

Eyelid malpositions

Ptosis: when a drooping upper lid is not down to the skin

An upper lid that sits lower than it used to — or lower than the other one. With a ptosis that is not down to excess skin but to the lid-lifting muscle: the muscle that holds the lid up. This distinction is no nicety for the medical report. It decides which procedure helps at all, who pays for it — and whether something is behind the drooping upper lid that cannot wait until next week.

Call now — have a drooping lid assessed book an appointment online

What a ptosis is

Almost everyone describes the same thing: an upper lid that sits lower than it used to, or lower than the one on the other side. It shows up first in photographs from a few years ago. Some people notice it because they raise the forehead or tip the head slightly back in order to see out over the lid margin — often without noticing that they do.

In everyday speech it is simply called a drooping upper lid. The medical report says Ptosis, in its long form Blepharoptosis. All three terms mean the same thing: an upper lid margin that sits too low.

Responsible for that is the lid-lifting muscle — the muscle that raises the upper lid and holds it up. It attaches to the lid through a very fine, broad tendon. If this tendon loses its attachment over the years, or the muscle loses power, the lid margin sinks, even though the skin above it can be entirely unremarkable. That is the whole difference from a hooded eyelid — and the reason why tightening the skin changes nothing about a ptosis: it leaves the lid margin exactly where it was.

That is not measured in the mirror but by a figure: the distance between the light reflex in the middle of the cornea and the upper lid margin. It says how far the lid reaches into the line of sight. Together with the excursion of the lid-lifting muscle — how many millimetres the lid moves when the forehead is held still — it separates the forms that look the same from outside, and later determines what has to be operated on.

A ptosis can affect one eye or both, have been there since birth or have appeared newly, stay the same or vary over the course of the day. Each of these points in a different direction, and that is why we ask about it in conversation before we measure anything. The most important point first: A lid that slowly gets lower over years is something else from one that droops within hours or days. The second case needs assessing at once — see the section on warning signs further down.

Ptosis, hooded eyelid or brow ptosis — what is actually drooping

From the outside, three different findings look almost the same: the eye appears smaller, the gaze heavier, the lid lower. Surgically they have almost nothing to do with one another. If the wrong one is operated on, the result is faultless in its craft and disappointing all the same.

Ptosis — the lid margin sits too low

The lid margin itself has dropped and covers more of the iris than it used to or than on the other side; where the finding is pronounced it reaches down over the pupil. Often the lid crease also sits higher than on the other eye, because the loosened tendon pulls it upwards. What is treated is the lid-lifting muscle. If the lid margin sits too high instead, so that a strip of white shows above the iris, it is not a ptosis but an upper lid that sits too high and has a cause of its own — what is then treated is not the lid-lifting muscle but whatever is pulling the lid up.

Hooded eyelid — too much skin over a correctly sitting lid margin

Here the amount of skin is the issue, not the muscle. The self-check: lift the fold of skin slightly, close above the lashes, without moving the brow. If the view opens up immediately, it is about skin. How that is assessed and billed is set out in detail on the page Hooded eyelids — too much skin, and the question of who pays for the surgery. The two can exist side by side; then both are dealt with.

Brow ptosis — the brow has dropped

The third possibility is the one most often missed. If the brow sinks, it pushes forehead skin ahead of it onto the lid. The test: lift the brow with your finger. If the fold largely disappears when you do, the brow is sitting too low — and an operation on the lid does not address the cause.

Pseudoptosis — a lid that only looks low

And then there are lids that sit low without the lid-lifting muscle being at fault: with a sunken or smaller eyeball, after an injury to the eye socket, with swelling that weighs the lid down, or with a lid pulled downwards by a growth on the eyelid margin. An eye screwed shut on one side from light sensitivity or irritation looks like this too. What is then treated is whatever is bringing the lid down.

This distinction is what also decides the cost question in Switzerland — exactly as with a hooded eyelid, only with a different finding in front of it. What makes an eyelid correction a medical service is not the impression in the mirror but a documented functional restriction. Where it is present, the correction is treatment of an illness. Where it is not, it is aesthetic and therefore self-pay. Which of these situations applies to you we tell you after the examination — including when the answer is 'aesthetic'.

A lid that droops suddenly is something else. If double vision and a wide pupil on the same side come with a newly drooping upper lid, go straight to an emergency department — do not wait for an appointment and do not wait until morning. The same applies to a drooping lid with a noticeably narrow pupil on the same side and pain in the throat or neck. If a disturbance of language, speech or swallowing, weakness in one half of the body, a drooping corner of the mouth, spinning vertigo, or a sudden severe headache come with it, call the ambulance (144). If instead an upper lid drops on its own and painlessly within days, call us the same day: +41 44 500 69 00; outside our consulting hours the ophthalmic emergency service applies.

Our rule on advice

We do not operate on a lid before it is clear why it sits low. If a nerve or muscle disease is behind it, that needs assessing and treating — an operation on the lid would remove the sign and leave the cause standing. And if a finding is not carried by basic health insurance (OKP), you hear that from us beforehand and not later from your insurer.

When a drooping upper lid is a warning sign

The great majority of ptoses develop over years and are harmless. A small proportion is the opposite: the lid is then not the problem but the sign. What decides that is not the lid itself but what comes with it — and that can be checked in a few seconds.

Straight to an emergency department, do not wait for an appointment: a newly drooping upper lid together with double vision and a wide pupil on the same side. This combination can come from a nerve palsy behind which there is a ballooning of a blood vessel. It is rare — and it is the reason this finding must not be left lying overnight, even when it does not hurt.

Equally at once: a drooping upper lid with a noticeably narrow pupil on the same side, together with pain in the throat, neck or face. A tear in a carotid artery can be behind it, one in which hours count.

Call the ambulance (144), not the ophthalmologist first: a drooping lid together with a disturbance of language, speech or swallowing, weakness or altered sensation in one half of the body, a drooping corner of the mouth, spinning vertigo, or a sudden, severe headache. That is an emergency of the whole person and not of the eye.

To be assessed the same day: an upper lid that has dropped within hours or days, without pain and without the signs above. And a lid whose height varies markedly over the course of the day — open in the morning, low in the evening —, because that can point to a disturbed transmission of signals from nerve to muscle. If difficulty swallowing or breathing, a weak or nasal voice or new double vision come with this form, it counts as an emergency and not as an appointment.

In all this, double vision is the sign that says the most — and the one most often played down. Newly appeared double vision in an adult is never cosmetic. What can be behind it, how it is examined and which combinations belong straight in an emergency department is set out on the page Squint and double vision — what is urgent in adults.

A word about driving: with double vision that has just appeared, you do not drive yourself. And if you are unsure whether your finding belongs in this section — call and describe it. With a drooping lid there is no wrong question.

Congenital or acquired — where a ptosis comes from

The cause determines everything that follows: whether the course is awaited, whether it is assessed, or whether it is operated on. That is why it comes at the beginning and not at the end.

The loosened lid-lifting tendon — the commonest form in adulthood

The fine tendon by which the lid-lifting muscle attaches to the lid loosens over the years, or comes partly away. The muscle goes on working, but its power no longer arrives fully at the lid margin. Typical is a slow course over years, often on both sides and unequal, with the lid crease sitting higher. It is encouraged by years of wearing hard contact lenses, frequent vigorous eye rubbing, recurring swelling of the lids and earlier eye operations — after cataract surgery, for instance, the lid often sits lower for a time, and in some of those affected it stays that way.

Nerve and muscle diseases

Here the lid is only the most visible sign. What comes into question is a palsy of the nerve that supplies the lid-lifting muscle, a disturbance of the sympathetic nerve network — recognisable from the narrow pupil on the same side —, a disturbed transmission of signals between nerve and muscle with a lid height that varies over the course of the day, and rare muscle diseases in which the eye movements also become slower. These forms are assessed and treated before an operation is even discussed. Where a neurological assessment is needed, we say so and organise the referral.

Mechanical causes

A lid can also simply be weighed down or held in place: by a growth on the eyelid margin, by scars after an injury or inflammation, by pronounced swelling. Whatever can be felt or seen at the lid needs assessing first. Which other findings on the lid we treat, and how they connect, is shown by the overview of the eyelid malpositions we treat.

Congenital

With a congenital ptosis the lid-lifting muscle is weaker from the outset. It is usually noticed in the first year of life, more often affects one eye only, and on looking down the lid often moves less than the healthy one. It is not something a child grows out of — and in children it has a consequence that does not exist in adults. There is a section of its own on that further down.

How we measure — the function of the lid-lifting muscle, the lid margin and the visual field

The eyelid consultation takes longer than a routine follow-up, and there is a reason for that: here things are measured rather than estimated. What ends up on paper decides the surgical planning and the cost question alike.

Eyelid measurements. Distance between the light reflex on the cornea and the upper lid margin, height of the lid crease, distance from lid margin to brow, amount of excess skin — separately for each side. These figures separate ptosis, hooded eyelid and brow ptosis from one another; looking alone does not.
Function of the lid-lifting muscle. The decisive figure: how many millimetres does the lid margin move from looking down to looking up, while the forehead is held still? It says how much power is still there at all — and on that depends which surgical approach comes into question.
Visual field measurement. Standardised, and twice: once as you come to us, and once with the lid held up. The difference between the two measurements is the evidence that the coverage question turns on.
Photographic documentation. Standardised images in the same head position and lighting, together with — where you have one — your old photograph. They form part of the application to your insurer and later the only fair comparison with the starting state.
Examination at the slit lamp. The lid margin, the position of the lashes, whether the lid closes completely, the tear film and the corneal surface. A dry eye or an inflamed lid margin is treated first, not operated on alongside.
Signs that point beyond the lid. Pupil width compared between the sides, eye movements, double vision, fatigability on prolonged upward gaze, the course over the day. If a pointer emerges here, it is assessed and not operated on.

By the end of this appointment you know three things: why the lid sits low, whether the finding is functionally relevant, and who would pay for a correction. If it is functionally relevant, we submit the findings, the measurements and the photographs to your health insurer before the procedure as an application for cost approval. We can carry out this measurement and document it — your insurer decides on it. A well-worded justification without a measurement does not carry the application.

How a ptosis is treated

The first step is not an operation but a decision: is the cause treated, or the lid? If a nerve or muscle disease is behind it, that is assessed and treated; the lid often improves along with it. After a nerve palsy, an injury or eye surgery, the course is watched over months and correction follows only once the finding is stable — a lid that is still recovering is not operated on.

If it remains the case that the lid margin sits too low, the correction is a procedure on the lid-lifting muscle. Through an incision that lies in the natural lid crease, the loosened tendon of the lid-lifting muscle is taken hold of again and attached to the lid in such a way that the lid margin sits higher; excess skin can be removed in the same session where there is some as well. The procedure is usually done as an outpatient under local anaesthetic. That you are awake for it is no disadvantage but part of the method: because you can open and close your eyes on request, the height can be checked while you sit up during the procedure.

How much may be raised follows not from what is wished for but from the measured function of the lid-lifting muscle and from the eyelid closure. If the function is very weak, a procedure on the tendon is not enough; other techniques then come into question, in which the lid is coupled to the forehead muscles. Which approach comes into question in your case at all we say after the measurement — and if a technique is better placed elsewhere, we say that too.

If there is marked excess skin alongside the ptosis as well, the two are brought together in one plan. How tightening the skin alone works, what it can achieve and what it cannot, is described on the page The procedure, preparation and aftercare of upper eyelid surgery. The reverse also holds: if only the skin is tightened in a ptosis, the lid margin stays exactly where it was before.

What is realistically possible — and what is not

The aim is a lid margin that leaves the pupil clear and looks right in the face, an upper edge of the visual field that is clear given the corresponding baseline findings, and a forehead that no longer has to hold up constantly. What is not promised is exact symmetry: no face is symmetrical, lid height responds in the range of millimetres, and where only the lower of two unequally drooping lids is raised, the other can sink somewhat afterwards. We check for that beforehand by raising the lower lid experimentally and watching the other side.

The risks include over- and under-correction with the possibility of a corrective procedure, differences between the sides, eyelid closure that is incomplete at first with dry, burning eyes, swelling and bruising over one to two weeks, temporary altered sensation along the scar, and a scar in the lid crease that fades over months. Less common are post-operative bleeding, infection and problems with wound healing; very rare are serious complications up to and including an impairment of vision. No procedure on the eye is without risk, and we discuss these points openly with you beforehand. Percentages and before-and-after promises are therefore not to be found on this page.

The eyelid findings are assessed at all three locations in Zurich, Wetzikon and Meilen.

Ptosis in children

In a child a drooping upper lid is not the same question as in an adult. An adult sees worse for as long as the lid is in the way, and well again as soon as it is raised. In a child the brain is still learning to see — and an eye that persistently delivers a poorer image is set aside during that time. If that goes unnoticed, it stays weak-sighted, even though the eye itself is soundly built.

Three routes lead there, and all three are the reason a ptosis in childhood should be looked at early: the lid covers the pupil completely or at times. Or it presses on the cornea and distorts it, so that the eye forms a blurred image even though the pupil is clear — that is not seen from outside and is found only by measuring. Or the child holds the head permanently with the chin raised, in order to see out under the lid.

That is why with children it is first about the visual acuity of each eye separately, about the refractive power compared between the sides and about the head position — and only after that about the lid. Some childhood ptoses are watched and followed up at first, others corrected early; that is decided by the finding and not by age. What is not true in any case is the phrase 'they grow out of it'.

How we examine children's eyes, what weak sight is and which time frame counts in it is set out on the page how we examine children's eyes and when a specialist consultation is the better place. The framework there applies here too: we examine children from kindergarten age; with babies and toddlers we establish on the phone whether a consultation specialising in paediatric ophthalmology is the better place, and help with the way there. Where a surgical correction comes into question for a child, we assess, judge the urgency and organise the referral to a specialist centre.

If you would like to have a drooping upper lid assessed — your own or your child's — that can be done by phone on +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30, or book an appointment online for the eyelid consultation. Bring the old photograph with you — it answers half the consultation.

Costs & health insurance

What does the insurer pay for — and what not?

With a ptosis the answer hangs on a single point: whether a functional restriction has been demonstrated — usually through the visual field, in children through the risk of weak sight. Everything else follows from that; what it means in practice is set out here.

Service	Coverage	What this means for you
Ophthalmic assessment of a drooping upper lid	Basic health insurance, where symptoms are the reason	If you come with symptoms — a restricted field of view, tension in the forehead, a newly dropped lid — the assessment is treatment of an illness; the deductible and co-payment apply as at any doctor's appointment. If you want a purely aesthetic correction from the outset, the preliminary examination belongs to the cost estimate.
Eyelid measurements, function of the lid-lifting muscle, visual field with and without the lid held up, photographic documentation	Same as for the assessment	The evidence that everything turns on. Where the assessment is done because of symptoms, it is covered even when it shows that there is no functional restriction — it is not tied to a particular result.
Further assessment where a nerve or muscle disease is suspected	Basic insurance (OKP)	If the pupils, the eye movements or a varying course give a pointer, the further assessment is treatment of an illness — regardless of whether the lid is ever operated on. Where a neurological opinion is needed, we organise the referral.
Correction of the lid-lifting muscle with a demonstrated functional restriction	Basic health insurance, after cost approval	We submit the findings, the measurements and the photographs to your insurer before the procedure. The decision is made there. We operate only once the written approval is in — so that you do not receive a bill afterwards that you had not reckoned with.
Correction without functional restriction (aesthetic procedure)	Self-pay	You receive a written cost estimate before the procedure. Supplementary insurance as a rule does not cover purely aesthetic procedures; whether your policy makes an exception is something only your insurer can tell you.
Combined procedure — functional part plus aesthetic additional service	split billing	The medically justified part goes through basic health insurance, the part beyond that through you. What belongs to which we set down in writing before the procedure, not after.
Follow-up checks, suture removal and any corrective procedure	Same as for the procedure itself	Aftercare follows how the operation is classified. With a functional procedure it goes through basic health insurance; with an aesthetic one it is included in the cost estimate. Whether a corrective procedure is needed only shows once the swelling has settled.

There are deliberately no amounts here: what is involved depends on the findings, and a figure without an examination would be a guess. You receive the cost estimate in writing after the assessment, before you have to decide.

A tax point that surprises many: with purely aesthetic procedures VAT is added; with medically indicated treatment it is not. That too is in the cost estimate.

Related conditions

Hooded eyelids Eyelid malpositions Paediatric ophthalmology

Medically reviewed by PD Dr. med. Andrea von Rückmann

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions

: When the finding is functionally relevant. The most common and clearest evidence for that is a restriction of the upper visual field that demonstrably improves when the lid is raised — the correction is then a medical service and goes through basic health insurance. There are also further functional reasons that can likewise count as treatment of an illness: a lid margin that reaches down over the pupil, a head position with a raised chin forced by it, or in a child the risk of weak sight. Demonstrating that is done with a standardised visual field measurement, once in the starting state and once with the lid held up, together with eyelid measurements and photographic documentation. We submit these documents before the procedure as an application for cost approval; the decision is made by your insurer, not by us. If there is no functional restriction, the correction is an aesthetic service and therefore self-pay; in the medical case the deductible and co-payment apply as with any other procedure.
: The place where the problem sits. With a hooded eyelid there is too much skin over the lid crease, while the lid margin itself sits where it belongs — what is removed is therefore skin. With a ptosis the amount of skin is not the issue: the lid margin itself sits too low, because the lid-lifting muscle or its fine tendon at the lid has lost power or its attachment — what is dealt with is therefore the lid-lifting muscle. A rough self-check helps to tell them apart: lift the fold of skin slightly, close above the lashes, without moving the brow. If the view opens up immediately, it is about skin. If the lid margin stays low over the iris, it is about the lid-lifting muscle. Both can be present at once, and then both have to be dealt with — otherwise the result is technically faultless and disappointing all the same.
: That depends entirely on the cause, and that is why the cause is established first. A lid that sits lower after eye surgery, after marked swelling or after an injury often recovers over weeks to months. A lid that droops as part of a nerve palsy can likewise recover — which is why in such cases the course is awaited and surgery follows only once the finding has been stable for months. If the lid height varies over the course of the day, a disorder of the transmission of signals between nerve and muscle is in question; what is then treated is that disorder and not the lid. What does not resolve on its own is the commonest form in adulthood: a lid-lifting tendon that has loosened over years. It stays, and slowly increases.
: It happens, and it is usually temporary. The lid speculum, the anaesthetic, swelling and the handling of the lid can change the lid height for a few weeks; in most cases the lid finds its old position again. If it is still sitting lower after about three to six months, a loosened lid-lifting tendon is often behind it — a predisposition that was already there beforehand and that the procedure has made visible. That is readily correctable, but not something to go on waiting over. Have it measured; nothing more than an examination is needed for that to begin with.
: It depends on the accompanying signs, and the three that decide it can be checked in ten seconds: are you seeing double? Are the pupils unequal in size? Do you have severe pain in the head, neck or eye? A newly drooping upper lid together with double vision and a wide pupil on the same side belongs straight in an emergency department — do not wait for an appointment, and not overnight either. The same applies to a drooping lid with a noticeably narrow pupil on the same side and pain in the throat or neck. If a disturbance of language, speech or swallowing, weakness in one half of the body, a drooping corner of the mouth, spinning vertigo, or a sudden severe headache come with it, call the ambulance (144): that is an emergency of the whole person and not of the eye. If instead the lid drops within days on its own, painlessly and without these signs, call us the same day.
: The aim is a lid height that opens up the view and looks right in the face — nobody can promise you exact symmetry in good faith. No face is symmetrical, and lid height responds in the range of millimetres. On top of that comes an effect that surprises many people: if both lids droop to different degrees and only the lower one is raised, the other can sink somewhat afterwards — the brain drives the two lid-lifting muscles together, and the extra drive for the poorer lid falls away. We check for that before the procedure by raising the lower lid experimentally and watching the other side, and we plan accordingly. A corrective procedure is possible and is needed in some cases; that belongs said beforehand and not afterwards.
: Creams, serums and massage devices do not raise any lid margin; they do not even reach the muscle that is at issue. Lid tapes and adhesive strips lift the lid crease mechanically for a few hours — they pull on very thin skin, are better suited to an occasion than to everyday use, and with frequent use they irritate the skin of the lid. There is one genuine, rare alternative: a lid support fixed to the spectacle frame that raises the upper lid mechanically. It is used where surgery is not to be done, or not yet permitted — while a nerve palsy is recovering, for instance, or with a muscle disease that is progressing. It does not remove the cause, but it bridges the gap. Whether that makes sense in your case we say after the examination.

Measure first, then decide.

In the eyelid consultation we establish in a single appointment why the lid sits low, whether your visual field is restricted and who would pay for a correction. You decide afterwards — not before.

Call now — appointment at the eyelid consultation

+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or book an appointment online.