Examination of the Conjunctiva

The conjunctiva is examined by direct inspection. The bulbar conjunctiva is directly visible between the eyelids; the palpebral conjunctiva can only be examined by everting the upper or lower eyelid. The normal conjunctiva is smooth, shiny, and moist. The examiner should be alert to any reddening, secretion, thickening, scars, or foreign bodies.

Eversion of the lower eyelid. The patient looks up while the examiner pulls the eyelid downward close to the anterior margin (Fig. 1.7). This exposes the conjunctiva and the posterior surface of the lower eyelid.

8 1 The Ophthalmic Examination Examination of the lower eyelid and inferior fornix.

8 1 The Ophthalmic Examination Examination of the lower eyelid and inferior fornix.

Inflammation The Eyeball Scleritis
Fig. 1.7 The lower eyelid must be everted for this examination. The patient looks up while the examiner pulls the eyelid downward close to the anterior margin.

Eversion of the upper eyelid. Simple eversion (Fig. 1.8). The patient is asked to look down. The patient should repeatedly be told to relax and to avoid tightly shutting the opposite eye. This relaxes the levator palpebrae superioris and orbicularis oculi muscles. The examiner grasps the eyelashes of the upper eyelid between the thumb and forefinger and everts the eyelid against a glass rod or swab used as a fulcrum. Eversion should be performed with a quick levering motion while applying slight traction. The palpebral conjunctiva can then be inspected and cleaned if necessary.

— Examination of the upper eyelid (simple eversion).

— Examination of the upper eyelid (simple eversion).

Eyelid Examination

Fig. 1.8 The patient relaxes and looks down. The examiner places a swab superior to the tarsal region of the upper eyelid, grasps the eyelashes of the upper eyelid between the thumb and forefinger, and everts the eyelid using the swab as a fulcrum.

Full eversion with retractor. To expose the superior fornix, the upper eyelid is fully everted around a Desmarres eyelid retractor (Figs. 1.9a and b). This method is used solely by the ophthalmologist and is only discussed here for the sake of completeness. This eversion technique is required to remove foreign bodies or "lost" contact lenses from the superior fornix or to clean the conjunctiva of lime particles in a chemical injury with lime.

Examination of the upper eyelid and superior fornix (full eversion with-

retractor).

Figs. 1.9a and b In this case, the examiner everts the eyelid around a Desmarres eyelid retractor. In contrast to simple eversion, this procedure allows examination of the superior fornix in addition to the palpebral conjunctiva.

Examination of the upper eyelid and superior fornix (full eversion with-

retractor).

Upper Palpebral Conjunctiva Examination
b

10 1 The Ophthalmic Examination

Blepharospasm can render simple and full eversion very difficult especially in the presence of chemical injury. In these cases, the spasm should first be eliminated by instilling a topical anesthetic such as oxy-buprocaine hydrochloride eyedrops.

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Responses

  • filibert
    How to examination conjunctiva?
    2 years ago
  • reija lepp
    How is the conjunctiva examined?
    2 years ago
  • Amanuel Tesfalem
    How to exam bulbar conjactiva?
    1 year ago
  • Johnnie
    How is the PALEBRAL CONJUCTIVAE AND BULBAR OF THE EYE noted in an eye exam?
    3 months ago
  • Linda Sandheaver
    How to assess the palpebral conjunctiva?
    14 days ago

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