Required Materials
- Lamp [Figure 34].
- Cotton bud.
- Forehead loupe.
Figure 34
Procedure
Sit down opposite the patient and make sure that there is a good level of illumination of the eye without blinding the patient.
Assess:
- Skin surrounding the eyes (colour, swelling, intactness).
- Skin of the eyelids (colour, swelling, intactness).
- Eyelashes – do they ‘brush’ across the eye? Are the sebaceous glands inflamed?
- Opening of the tear duct (place index finger just beside the nasal bridge and pull the lower eyelid downwards).
- Presence of discharge from these structures.
- Shape of the eyelid crease.
Inspection Of The Tarsal Conjunctiva
To turn over the upper eyelid:
- Place the rod of a long cotton bud onto the upper eyelid, just where the eye disappears into the eye socket [Figure 35]. The patient should be looking downwards.
Figure 35
- With the other hand, hold the eyelashes of the upper eyelid and pull the eyelid over the rod, whilst moving downwards and towards yourself [Figure 36].
Figure 36
You will now be able to inspect the tarsal conjunctiva.
Assess:
- Colour of the mucous membrane, presence of conjunctival injection, redness.
- Intactness of the mucous membrane.
- Presence of swellings and if present, their shape, size, consistency and colour.
- Presence of discharge from these structures.
To be able to inspect the tarsal conjunctiva of the lower eyelid:
- Place an index finger approximately one centimetre below the edge of the lower eyelid.
- Pull the skin of the lower eyelid downwards.
- The patient looks up.
You will now be able to inspect the tarsal conjunctiva and the part of the bulbar conjunctiva that is covered by the lower eyelid.
Assess:
- Colour of the mucous membrane, presence of conjunctival injection, redness.
- Intactness of the mucous membrane.
- Presence of swellings and if present, their shape, size, consistency and colour.
- Presence of discharge from these structures.