Chapter 14: The Eyes

BASIC KIT FOR EYE EXAMINATION

As recommended by the Royal Victorian Eye and Ear Hospital, an eye kit should include equipment for removal of corneal foreign bodies, and eye-testing charts at 18 inches (46 cm) and 10 feet (305 cm):

• multiple pin holes

• fluorescein sterile paper strips, e.g. Flourets

• torch

• eyelid speculum

• magnification (necessary to examine cornea)

• sterile isotonic saline solution to irrigate eyes

• local anaesthetic (oxybuprocaine 0.4% e.g. Minims unidose)

• sterile cotton buds

• glass rod to double-evert eyelids in chemical burns

• non-allergenic tape (e.g. Micropore).

Eye tip: The eye holds only one drop of liquid, which usually remains in the eye for only a few seconds. The action can be prolonged by pinching on either side of the nose to occlude the lacrimal duct for 60 seconds.

EVERSION OF THE EYELID

Paperclip method

No eye examination is complete without eversion of the upper eyelid to exclude hidden pathology, particularly a foreign body.

The method generally taught is to evert the lid over a matchstick, but this can be difficult. The use of a paperclip can simplify this examination.

1. By bending the long arm of the paperclip to make a right angle, you can create an instrument with a fine diameter, which is easy to withdraw and has a handle that keeps fingers out of the field of inspection (Fig. 14.1).

2. Care must be taken not to slide the end of the clip over the lid but to place it gently and precisely along the appropriate line (about 15 mm from the edge of the lid and parallel to it).

3. You must also make sure not to slide the end of the clip across the lid and scratch it on removal.

Care must also be taken with uncooperative children.

Cotton bud method

The use of a cotton bud is recommended for eyelid eversion. Its effectiveness depends on correct placement.

1. Ask the patient to put the chin up and to look down.

2. Gently grasp the eyelashes of the upper lid between the index finger and thumb of the non-dominant hand and pull gently downwards.

3. Apply the cotton bud 15 mm above the upper eyelid margin.

4. With gentle pressure, push the bud back while lifting the lashes upward.

5. Eversion of the lid can be maintained even after removal of the cotton bud.

BLEPHARITIS

Blepharitis is inflammation of the lid margins and is commonly associated with secondary ocular effects such as styes, chalazia and conjunctival or corneal ulceration. There are two main causes or types:

• anterior blepharitis—staphylococcal

• posterior blepharitis—seborrhoeic and rosacea: associated with ...