Comm Eye Health Vol. 18 No. 55 2005 pp 110. Published online 01 October 2005.

How to evert the upper eyelid and remove a sub-tarsal foreign body

Sue Stevens

Ophthalmic Resource Coordinator/Nurse Advisor, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

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Remember – wash your hands before and after performing all procedures!

Indications

  • To examine the upper tarsal conjunctiva
  • To remove a foreign body (FB) and so relieve pain
  • To prevent a corneal abrasion and limit further damage.

Never evert the upper eye lid if a penetrating injury or corneal thinning (e.g., due to ulceration) is suspected.

You will need

  • Cotton buds, paper clip or small blunt object, e.g., pen top
  • Magnification
  • Sterile needle
  • Local anaesthetic drops
  • Fluorescein strips
  • Saline or cooled boiled water
  • Prescribed antibiotic eye drops or ointment
  • Tape, two eye pads and bandage.

Preparation

  • Explain the procedure, advising the patient that he/she may experience a brief increase in discomfort but that it is important to relax and keep still
  • Reassure and encourage him/her by stressing that relief should be felt immediately after the FB is removed.
Picture 1. Turn the eyelid against steady and gentle pressure on the upper eyelid. © Murray McGavin
Picture 1. Turn the eyelid against steady and gentle pressure on the upper eyelid. © Murray McGavin
Picture 2. The eyelid will evert to reveal the upper tarsal conjunctiva. The FB may be large enough to be seen easily. © Murray McGavin
Picture 2. The eyelid will evert to reveal the upper tarsal conjunctiva. The FB may be large enough to be seen easily. © Murray McGavin

Method

  • Instil a drop of local anaesthetic and fluorescein dye
  • Ask the patient to look down
  • With one hand, hold the eyelashes of the upper eyelid between thumb and index finger
  • With the other hand, place a cotton bud (or paper clip or other small blunt object) midway from the eyelid margin
  • Turn the eyelid against steady and gentle pressure on the upper eyelid (picture 1)
  • The eyelid will evert to reveal the upper tarsal conjunctiva. The FB may be large enough to be seen easily (picture 2)
  • With a gentle upward movement, remove the FB using a moistened cotton bud. It may be necessary to use a needle if it has embedded
  • If the FB cannot be seen, examine the eye again using a torch and magnification to ensure it is not missed
  • On completion of the sub-tarsal examination and removal of FB, ask the patient to look up and the eyelid will return to its normal position
  • Examine the rest of the eye for further particles
  • If a corneal abrasion has resulted, instil antibiotic eye drops or ointment and apply a firm eye dressing, using two pads (a bandage may be added), for 24 hours (pictures 3 and 4).

Review the eye after 24 hours or earlier if pain persists.

Finally

  • Wipe needle with a swab to confirm removal of FB and show it to the patient – this will reassure him/her it has been removed
  • Dispose of needle carefully in an appropriate container.
Picture 3. If a corneal abrasion has resulted, instil antibiotic eye drops or ointment and apply a firm eye dressing, using two pads (a bandage may be added), for 24 hours. ©  Murray McGavin
Picture 3. If a corneal abrasion has resulted, instil antibiotic eye drops or ointment and apply a firm eye dressing, using two pads (a bandage may be added), for 24 hours. © Murray McGavin
Picture 4. Applying a firm eye dressing, using two pads (a bandage may be added). © Pak Sang Lee
Picture 4. Applying a firm eye dressing, using two pads (a bandage may be added). © Pak Sang Lee