contact lens practice pearls
Easy Eyelid Eversion
BY THOMAS G. QUINN, OD, MS, FAAO
The condition of the palpebral conjunctiva overlying the collagenous plate of the upper eyelid can have a marked impact on a patient's ocular comfort. Indeed, it can profoundly affect a patient's ability to wear a contact lens. Why then do I often hear contact lens patients new to my office remark, "I've never had that done before" following upper eyelid eversion?
Here's an efficient and easy way to do what you should be doing on all of your contact lens candidates and wearers.
Eyelid Eversion Technique
While performing your examination of the cornea and bulbar conjunctiva, keep patients in place in the slit lamp and ask them to look down, keeping both eyelids relaxed and open. Asking patients to keep the fellow eye open will ease examination by relaxing the eyelids of both eyes.
Figure 1. Place your thumb just below the brow.
Figure 2. Grasp the area of the lid and lashes.
Figure 3. Pin the lid margin against the brow.
When examining the right eyelid, reach around the slit lamp with your left hand and place your thumb on the uppermost portion of the upper eyelid, below the brow (Figure 1). The idea is to let the thumb work as the fulcrum point around which the lid eversion will take place. The thumb takes the place of other devices commonly employed, such as a swab. It's critical to place your thumb high enough so that it rests above the collagenous plate within the upper eyelid.
Reach around the other side of the slit lamp with your right hand and grasp between your thumb and forefinger the central area of the upper eyelid margin and lashes (Figure 2). Pull the eyelid away from the eye and then in an upward direction with your right hand while simultaneously pushing down on the superior region of the lid with the thumb of your left hand. Once you are able to pin the lid margin against the brow, you can release one hand to manipulate the slit lamp for examination of the superior tarsal plate (Figure 3).
The beauty of this technique is its efficiency. It takes place entirely behind the slit lamp so you don't need to ask the patient to move, and because you substitute your thumb for a swab or ruler, there's no need to stop your exam to acquire these other devices.
Implementing Into Practice
If you haven't tried this technique before, start on an adapted lens wearer who has prominent eyes. Non-adapted wearers may be more resistant, and deep-set eyes can be more challenging. The most common mistake is not exerting enough force to accomplish the task. The elasticity of the eyelids make them very forgiving when dealt with firmly. After some practice, you'll find you rarely need to acquire a swab to look at an eyelid. Try it on every patient! CLS
Dr. Quinn is in group practice in Athens, Ohio. He is a diplomate of the Cornea and Contact Lens Section of the American Academy of Optometry, an advisor to the GP Lens Institute and an area manager for Vision Source.