Crusting on the eyelids.
(4) Adequacy of eye cover. Check for entropion (eyelid margin turning
inward and causing eyelashes to rub on the cornea) or ectropion (eyelid edge turns
h. Check Lacrimal Apparatus.
(1) Lacrimal gland region inspection. Lift up the bottom part of the upper lid;
direct the patient to look down and to the opposite side. Look to see if the lacrimal
gland is swollen and sticks out between the upper lid and the eyeball.
(2) Lacrimal sac area inspection. Examine this area to see if there is
swelling. If the eye tears too much, press on the inside portion of the lower eyelid just
inside the orbital rim. Look to see if fluid comes out of the lacrimal duct openings.
Examine the area for tenderness by palpation. If the lacrimal sac is acutely inflamed,
take care to press very gently.
Examine both the palpebral and bulbar portions of the conjunctiva.
(2) Examine the inferior sac. Pull down the skin beneath the eye. Have the
patient look upward.
j. Cornea. To look for corneal abrasions, shine a light from a penlight so that
the side of the cornea is illuminated. Use a fluorescein strip to stain any corneal
abrasion you may find. Fluorescein is a solution which may cause infection. Follow this
(1) First, moisten the strip with a sterile solution of water or saline. Then
touch the strip to the lower cul-de-sac.
Take care not to stain anyone's clothes, yours or the patients'.
The dye will drain into the nasal cavity.
k. Corneal Sensitivity. Check corneal sensitivity by touching a cotton wisp to
the cornea and observing whether the patient blinks. Touching the eyelashes
invalidates this test. Touching the eyelashes stimulates a different reflex.
Pupils. Inspect pupils for the following:
Inspect the pupils for equality and roundness.
Pupils equal and reactive to light (PEARL).