Passport photo with a medical condition or facial injury: what is allowed, what needs a signed statement, and where the public guidance goes quiet

A note about the sources

Rules and procedures change. The Foreign Affairs Manual, including 8 FAM 402.1, is guidance for passport staff, rather than a promise about how any individual application will be handled. Before applying, check travel.state.gov for the current photo requirements and the instructions for your application route.

The practical answer

Start with what the State Department's public photo page says. It asks for a neutral facial expression with both eyes open and mouth closed, a direct view of the camera without tilting your head, and an original, unedited photo. It says to remove anything covering your face unless for documented religious or medical reasons. Its detailed guidance says to remove glasses unless you cannot do so for medical reasons and include a signed note from your doctor, and to remove a face covering or medical mask. It also excludes headphones and wireless hands-free devices. The page does not explain every case involving swelling, bandages, medical equipment or an inability to open both eyes. For those details, the Foreign Affairs Manual is useful.

The Foreign Affairs Manual is the guidance that passport staff work from, and you can read it online. On the points that matter here, it says the following.

Marks on the face caused by a medical condition, such as black eyes, swelling, cuts and abrasions, are acceptable, and there is no requirement that the condition be healed before a passport is issued.

Medical equipment and supports for the shoulders, head and neck may be visible in the background of the photo for applicants with medical conditions or disabilities, and a medical statement from a health practitioner may be requested in questionable cases.

A hearing device may be worn if it does not obscure the face.

Where bandages or medical equipment cover the face, such as ventilator tubing or an eye patch that obscures the face, the manual says a medical statement signed by a medical professional must be requested.

Both eyes should be visible and open. The manual addresses applicants who cannot open one or both eyes because of a medical condition and allows staff to accept the photo. A signed medical statement may be requested in questionable cases.

Eyeglasses are generally not acceptable but may be accepted if they cannot be removed for medical reasons, such as recent eye surgery. A medical statement must be requested in those rare cases, the frames must not cover the eyes, and there must be no glare, shadow or refraction obscuring the eyes.

That is an accommodating set of provisions. It is also guidance for staff rather than a checklist for applicants, so what happens to your application depends on how your photo and any statement are assessed.

Bruises, swelling, cuts and recent surgery

If your face is visibly marked by an injury or a medical condition, the manual's position is that the marks themselves are not a reason to reject the photo. A black eye, swelling, cuts and abrasions are listed as acceptable. The photo is meant to be a true likeness of how you look, and the manual does not require you to wait until those marks have healed.

There is a practical side to this. The public photo page says that you should apply for a new passport after a major change in your appearance, and it lists significant facial surgery or trauma, adding or removing many large facial piercings or tattoos, and significant weight loss or gain. It lists minor changes, such as growing a beard, colouring your hair or the normal ageing process, as not needing a new passport. PassSnap already has a separate guide on when to renew after an appearance change.

What the two sources do not tell you is whether you should wait for swelling to go down before applying. The manual says healing is not required. That does not mean it is always the best choice for you, because a photo taken at the worst point of a bruise may look less like you than one taken a few weeks later, and a passport lasts a long time. If your travel is not urgent, waiting may be sensible. If it is, the manual's position gives you room to go ahead.

Bandages, eye patches and equipment on the face

This is the category where a signed statement comes in. The manual says that when bandages or medical equipment obscure the face, such as ventilator tubing or an eye patch, a medical statement signed by a medical professional or health practitioner must be requested. In plain terms: expect to be asked for a statement, and consider having it ready rather than waiting to be asked.

The public photo page does not provide a statement template for these situations. A simple, factual statement signed by your practitioner that identifies you and explains that the item is worn for medical reasons is a practical starting point, rather than an official wording requirement. Check the State Department's current instructions or contact it through the channels listed on travel.state.gov if you are unsure what it needs.

Medical equipment that is not on the face is treated differently. The manual says supports for the shoulders, head and neck, and other medical equipment, may be visible in the background of the photo, and that a statement may be requested in questionable cases. If you use a wheelchair, a neck brace or a headrest, that does not need to be hidden, although the head and shoulders should still be shown clearly and the face should be fully visible where possible. PassSnap has a separate guide for photos taken by wheelchair users.

Face masks need particular care when reading the public page. Its detailed instructions say to remove face coverings and medical masks, while its opening summary mentions documented religious or medical reasons for a face covering. Do not assume that a precautionary mask will qualify. Follow the current instructions and ask the State Department about your circumstances if a covering cannot be removed for medical reasons.

Eyes that will not open fully

Open eyes are a standard photo requirement, and they are also a requirement that some people physically cannot meet. The public page requires both eyes open, with an exception for babies in its examples. The manual separately addresses applicants who cannot open one or both eyes because of a medical condition. It allows staff to accept the photo, with a signed medical statement potentially requested in questionable cases.

If a condition, a recent procedure or swelling makes it hard to open both eyes, the useful step is to take the best photo you can, with your eyes as open as is comfortable and your head straight, and to be prepared with a medical statement. Do not try to fix the problem in an editing app. The State Department says not to alter your photo using software, apps, filters or artificial intelligence and says it checks for AI use. An honest photo that needs assessment is a better starting point than one digitally changed to hide the issue.

Glasses worn for medical reasons

The public page says to take off your glasses, and says that if you cannot remove them for medical reasons you should include a signed note from your doctor. The manual adds detail: it gives recent eye surgery as an example, says a medical statement must be requested in these rare cases, and says the frames must not cover your eyes and there must be no glare, shadows or refraction obscuring them. Dark or tinted lenses are allowed only if the medical statement says they are required. PassSnap has a separate guide to the medical exemption for glasses, which goes into the details.

Hearing devices

Hearing aids are one of the situations the manual covers directly. A hearing device may be worn if it does not obscure the face. That is different from the public page's rule on headphones and wireless hands-free devices, which applies to consumer devices such as earbuds. If you wear a hearing aid, check in the live preview that it does not obscure your face. The manual's condition concerns visibility of the face; a hearing device should not automatically be treated as a consumer earbud.

Where people get surprised

The first surprise is that the public photo page and the manual say different amounts. A person who reads only the public page may still be unsure about a black eye, an eye patch or a hearing aid. The manual says marks from a medical condition are acceptable and that a hearing device is fine if it does not obscure the face. The sources are written for different readers, so it helps to read the public requirements alongside the relevant staff guidance.

The second surprise is that a statement may be requested rather than required in every case. For bandages and equipment covering the face, the manual says a statement must be requested. For open eyes and for equipment in the background, it provides for a statement in questionable cases. If you can arrange a statement before submitting, that may help you respond if one is requested, but the manual does not impose the same requirement on every situation.

The third surprise is the clock. If a photo does not meet the standards, the manual's usual response is to ask for a new one, and if the applicant does not respond within 90 days the application is denied without further action and fees are not refunded. That is a good reason to answer any request promptly and to include a statement upfront if the instructions for your situation call for it.

The fourth surprise is that the manual allows for emergencies. In an emergency, staff may accept a photo that does not meet every requirement, provided it is still a clear and current representation of the applicant, and the passport's validity is limited to one year. That is a decision for the State Department to make, and it is not something to plan around, but it is useful to know that an urgent situation is not treated as an ordinary one.

The fifth surprise is that the temptation to edit is strongest here. Someone with a bruise or a dressing may want to retouch it out. Do not. The photo is meant to show how you look. Removing a bruise, opening an eye digitally or hiding a dressing would change the very features the reviewer needs to assess.

What may change

Application routes and online procedures may change. If you apply online, check the current photo instructions for that route. The pages used for this guide do not answer every practical question about submitting a medical statement online. Do not assume a particular upload process or opening date; check the State Department's current instructions before you apply.

How PassSnap fits

PassSnap helps you take the most accurate, unedited photo you can. The guided capture checks head size, eye line and framing as you shoot, the timer lets a helper or a stand take the photo so you are not reaching for the screen, and the optional AI verify step flags common issues such as glasses, expression and background problems before you print. For this situation, keep an original, unretouched photo rather than using edits to hide a bruise, dressing or other feature. The State Department does not allow altered photos.

PassSnap cannot decide whether your condition qualifies for any exception, cannot write or check a medical statement, and cannot tell you whether the State Department will accept a particular photo. Those decisions belong to the State Department and your health practitioner. A flag from an automated photo check is a prompt to review the issue; it cannot determine how a medical circumstance will be assessed.

Before you take the photo

Decide whether to wait. If your travel is not urgent and your appearance is changing quickly because of swelling, bruising or recent surgery, think about whether a photo taken later would look more like you. If you need the passport soon, the manual's position is that marks from a medical condition are acceptable and healing is not required.

Check what is on your face. If bandages, tubing or an eye patch cover part of your face, plan to include a medical statement signed by a health practitioner. If a hearing device is visible but does not obscure your face, that is generally fine under the manual.

Take off a precautionary face mask and any glasses you can remove for the photo. If a covering cannot be removed for medical reasons, check the current State Department instructions. If you cannot remove your glasses for medical reasons, include a signed note from your doctor and make sure the frames do not cover your eyes and there is no glare.

Set up for a straight, even photo. Sit or stand facing the camera with your head level, with soft even light on your face from the front, and a plain white or off-white background with no shadows. If you use a wheelchair or head and neck supports, they may appear in the background, but keep your face fully visible where possible.

Open your eyes as far as you comfortably can, keep your mouth closed with a neutral expression, and take several shots. If you cannot open both eyes fully, keep the best honest photo and have a statement ready. Do not edit it.

Prepare any statement before you submit. Ask your practitioner for a signed statement that says what you wear or what condition affects the photo, and keep a copy. Check the State Department's current instructions or contact them if you are unsure what it should say.

Answer any request for a new photo or more information quickly. The manual's usual response to a photo that does not meet the standards is to ask for a new one, and an application can be denied if there is no response within 90 days.

Sources and related guides

• State Department: public passport photo requirements
• Foreign Affairs Manual: 8 FAM 402.1 (guidance for passport staff)
• When to renew after an appearance change
• Passport photos for wheelchair users
• Medical exemption for glasses

FAQ

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