Introduction

Eyelid eversion is a clinical technique used to expose and examine the superior palpebral conjunctiva.

Indications

1. All contact lens patients
2. Any patient with a history of eye allergies, or who presents with “itchy eyes”
3. Patients who report with foreign body sensation

Contra-Indications

Recent eyelid surgery or trauma

Materials

Sterile applicator (not necessary for the procedure)

Setup

1. Instruct your patient to look up.
2. Place the thumb of your temporal hand (depending on the eye being examined) on the patient’s lower lid, such that the fleshy side of the thumb rests points towards the ceiling.  Position the thumb such that, when the patient closes their eye, their eyelashes just fall on top of the thumb (approximately 1/4″ below the lower lid margin).
3. Instruct the patient to close their eyes.  Pinch the upper eyelashes between your index finger and thumb.  Using the lashes, pull the upper eyelid slightly down and away from the eye.
4. From the nasal side, hold the sterile applicator in your other hand at a 45 degree angle above horizontal.  Place the tip of the applicator just above the tarsal plate in the horizontal middle of the lid.
5. To perform the actual eversion, pull the lid up while you momentarily push the sterile applicator slightly downwards.  Hold the everted lid in place while you examine the palpebral conjunctiva with the slit lamp.  If necessary, release pressure on the lid and slide your finger up to prevent your finger from blocking your view of the superior palpebral conjunctiva
6. When done, un-evert the lid by instructing the patient to look up, while you slide your thumb down over the lid margin.

Results

Severity of papillae can be graded on a scale of 0, 1+, 2+, 3+ or 4+

A papillary response may indicate a sensitivity to contact lens material or to environmental agents.  A foreign body in the superior palpebral conjunctiva should be visible during eversion of the upper eyelid.  If a foreign body is visible, it should be removed if indicated.

References