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

Related content

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.

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.