Everting an eyelid

The examination

Begin by making the patient feel comfortable, explain what you will do and re-assure them that it feels strange but does not hurt. Have the patient sitting or standing in a comfortable area that is not in direct sunlight (indoors or shade).

Instructions to give the patient

  1. Sit up straight.

  2. Chin up.

    Position the patients head so that it is tilted backwards at about 20 degrees.

  3. Look down.

    The patient should then look down with their eyes. This should have them looking roughly at a position on your chest.

    You can use a prompt such as look at the button on my shirt.

Instructions for the examiner

  1. Always examine the right eye first then the left to avoid confusion in recording results.
  2. Gently grasp the top eyelid at about the junction of the medial and middle thirds.
  3. Pull the eyelid gently. It should first be pulled straight away from the globe and then in a downward direction to stretch the upper eyelid.
  4. This should expose the crease at the top of the firm tarsal plate. Place the fulcrum above the crease.
  5. The eyelashes are then pulled up as the fulcrum is pushed down slightly, everting the eyelid.
  6. Remove the fulcrum.
  7. Examine the eyelid using a binocular 2.5× loupe and torch. The eyelashes can be pressed against the brow while the eyelid is examined.
  8. Invert the eyelid.
  9. Ask the patient to blink several times.