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    Why you should add upper lid eversion to your comprehensive exam

    The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

    ODs identify a number of conditions while performing a comprehensive ocular examination. Undiagnosed diabetes, hypertensive retinopathy, or other systemic condition may be identified during a patient’s eye exam.

    A common slit lamp evaluation technique that may help uncover both local ocular and systemic problems—upper eyelid eversion (UEE). It is so important that we perform it on every patient. This provides significant information about patients’ ocular surface and systemic health.

    Previously from Dr. Brujic and Dr. Kading: Work with patients to combat contact lens obsolescence

    Palpebral conjunctiva health

    Everting the upper eyelid gives ODs an indication of the health of the palpebral conjunctiva. In a normal contact lens-wearing individual, we expect to see a smooth tarsal surface. In a patient who is abusing his contact lenses, the normally smooth, healthy tarsal surface may develop significant irritation and hyperemia.Figure 1. Giant papillary conjunctivitis (GPC)

    In some individuals, this may lead to giant papillary conjunctivitis (GPC). In the most severe forms, GPC is identified by the patient’s symptoms which may include fluctuating vision, uncomfortable contact lenses, and also lenses that seem to move significantly with the blink. This may occur because the large papillae formed will adhere to the lenses and may cause significant movement with the blink.

    Early to moderate forms of GPC present in a more subtle way. Most patients complain about comfort. Often this will lead the clinician to refit contact lenses to optimize comfort when in fact it is a problem with the health of the palpebral conjunctiva. By performing an upper eyelid eversion on every patient, you may easily uncover GPC and provide better treatment options for patients.Figure 2. Lid wiper epitheliopathy (LWE)

    LWA becomes visible

    Also visible upon UEE is the lid wiper area (LWA). This is the small tissue located posterior to the meibomian glands on the upper eyelid. The LWA is responsible for physically “wiping” along the ocular surface during the blink. In the presence of poor tear film, increased friction occurs between the LWA and the ocular surface. In this instance, vital dyes applied to the eye will be absorbed in the irritated tissue. This is termed lid wiper epitheliopathy (LWE).

    Dyes that will stain this region are:

    • Fluorescein

    • Lissamine green

    • Rose bengal

    Mile Brujic, OD, FAAO
    Dr. Mile Brujic practices in Bowling Green, OH. He also owns Optometric Insights, a service providing career coaching to optometrists.
    David Kading, OD, FAAO, FCLSA
    Dr. Kading owns a two-location, three-doctor practice in Seattle. He specializes in dry eye and contact lenses with an emphasis on ...


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