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Benign lid lesions – Information for GPs

Referral criteria / commissioning position

Treatment of the following procedures are not commissioned:

  • Cyst of Moll
  • Cyst of Zeis
  • Eyelid Papillomas and Skin Tags
  • Pinguecula (to aid differentiation b/w Pinguecula and Pterygium)

Refer to Ophthalmology only when there is diagnostic uncertainty; Otherwise, prior funding approval from the CCG’s IFR panel is required.

Other conditions


Trichiasis (ingrowing lashes):

  • refer if regrowth following removal, indicating number of lashes

Entropian (in turning lid):

  • Refer all as urgent risk of corneal damage, will probably need corrective surgery

Ectropian (out turning lid) – Not dangerous, may cause epiphora (watery eye)/soreness

  • Refer when conservative measures fail to control symptoms

Basal cell carcinoma

  • If on lid/medial canthus, or if excision is likely to distort eye lid (with 3mm margin) then to refer to ophthalmology
  • Refer as “suspected BCC” (2 week pathway if fast growing or suspicious of SCC)
  • Others as routine

Small lid masses

  • Only refer if visually disabling or possibility of being malignant

Meibomian cyst (inflammatory granuloma caused by obstruction of gland)

  • Refer if persistent (>6 months) and causing lid distortion to Ophthalmology minor ops for curettage and primary care intervention is unsuccessful

Dermatochalasis (excess upper lid skin)

  • Refer only if superior visual field defect – see community optometrist first


  • Refer routinely if confirmed superior field defect and patient wants surgery
  • Children <8y if involves visual axis refer to orthotics urgently risk of amblyopia

Epiphora (watery eye)

  • Refer to secondary care for syringing, if symptoms affecting sight. If puncti stenosed may need minor dilatation procedure. (Service Available at BTC and Probus)
  • for Dacryocystitis:
  • if severe with pre-septal orbital cellulitis refer to eye casualty
  • if resolving refer for routine clinic may need dacryocystorhinostomy (DCR)

Epiphora neonates

  • Refer as routine if epiphora after one year old for syringe and probe
  • Refer earlier if dacryocystitis

Dry eye

  • Refer to routine clinic only if severe symptoms despite regular lubricant, or staining of cornea
  • Refer urgently if severe staining, photophobia, loss of vision

If the patient does not meet any of the above criteria state reason for referral

Investigations prior to referral


Information to include in referral letter

  • Details of how the patient meets the criteria
  • Treatments and interventions, current & past tried including the results
  • Photograph is desirable if solitary lesion
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient Information Leaflets

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