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  • • Suspected foreign body or corneal abrasion.

    • History of eye trauma or irritability in a nonverbal patient.

    • Abnormal sensation or eye pain, foreign body sensation, photophobia.

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Absolute

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  • • Penetrating trauma and globe rupture.

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  • • Examination gloves.

    • Sterile isotonic irrigation solution (0.9% saline or lactated Ringer’s). Tap water at room temperature is an acceptable alternative to prevent treatment delay.

    • Topical ophthalmic anesthetic solution (proparacaine 0.5% or tetracaine 0.5%).

    • Cotton-tipped swab.

    • Eyelid retractor.

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  • • Pain or discomfort.

    • Eyelid laceration.

    • Contusion of the lid or globe.

    • Corneal abrasion.

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  • • Suspect an embedded eyelid foreign body when no object can be visualized and symptoms are persistent.

    • If possible, do not apply a topical ophthalmic anesthetic until a foreign body is visualized or you are confident that none is present.

    • • Patients can help localize a foreign body but sensation will be eliminated by the topical anesthetic.

      • Patient’s inability to feel increases the potential for abrasions since there is no further pain or apprehension with blinking, eye movement, or rubbing.

    • A smooth, uncoated metal clip can be bent to into an appropriate shape to be used as a retractor after sterilization with alcohol.

    • Copious irrigation and mechanical removal of a foreign body is necessary to prevent corneal abrasions, infections, ulcerations, perforations, and metallic rust rings.

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  • • Apply topical ophthalmic anesthetic solution after foreign body has been visualized or ruled out to decrease pain and facilitate procedure and eye examination.

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  • • Age-appropriate positioning and restraint as necessary to complete procedure and eye examination.

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  • • Eyelid margin: Junction of the internal and external portions of the eyelid where the eyelashes are located.

    • Palpebral fissure: Space between the upper and lower eyelid margins when the eyelids are open.

    • Medial commissure: Medial junction of upper and lower eyelids.

    • Lateral commissure: Lateral junction of upper and lower eyelids.

    • Lacrimal puncta: Located on the eyelid margin before the medial commissure.

    • Conjunctiva: Thin transparent membrane.

    • • Palpebral conjunctiva: Covers the inner surface of the eyelid.

      • Bulbar conjunctiva: Covers the anterior portion of the eye except for the central cornea.

      • Fornix: Transition between the palpebral and bulbar conjunctiva.

    • Muscles of the eyelid.

    • • Orbicularis muscle: Closes the eyelids.

      • Levator muscle: Opens the eyelids.

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Upper Eyelid Eversion

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  • • Ask the patient to direct gaze downward.

    • Grasp the eyelashes and distal upper eyelid between the index finger and thumb and pull downward.

    • Place a cotton-tipped swab across the mid-body of the upper eyelid.

    • In a single maneuver, move the swab downward and pull the eyelid upward (Figure 49–2), ...

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