Chapter 49. Foreign Bodies: Eyelid Eversion and Retraction

• • 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.

Absolute

• • Penetrating trauma and globe rupture.

• • 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.

• • Pain or discomfort.

  • Eyelid laceration.

  • Contusion of the lid or globe.

  • Corneal abrasion.

• • 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.

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

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

• • Figure 49–1 shows the anatomy of the eye.

• • 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.

Upper Eyelid Eversion

• • 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), bending ...