Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Examination of the Lids


Key Concepts

  • An anatomically and physiologically normal eyelid is vital in maintaining the health of the eye.

  • Observing unconscious behaviors while collecting the patient’s history may provide valuable insight into underlying disorders.

  • Examination should begin under ambient lighting prior to the administration of drops so as to reduce artifact.

  • Examination of the tear film yields valuable information in the diagnosis and treatment of dry eye.

  • Examination of the posterior eyelid may reveal significant meibomian gland dysfunction (MGD), which can alter the mucocutaneous junction.

  • Meibomian gland expression is an important part of the eyelid examination and is helpful in distinguishing seborrheic from obstructive MGD.

  • Meibography provides information on meibomian gland structure and may be a valuable clinical tool in the treatment of MGD.

General Principles

The health of the ocular surface is dependent on an adequately positioned and properly functioning eyelid. A systematic approach such as that outlined in Box 6.1 is helpful but should be modified as necessary.

BOX 6.1
A Recommended Order for Examination of the Patient’s Eyelids

  • Take history and observe unconscious behavior and habits.

  • Examine face and eyelids in ambient lighting.

  • Examine tear meniscus and puncta with slit lamp prior to administration of drops or dyes.

  • Examine anterior and posterior eyelid.

  • Express the meibomian glands.

  • Reexamine mechanical properties of the lids.

  • Instill dye (typically fluorescein, also lissamine green or rose Bengal).

  • Use slit lamp again to identify the mucocutaneous junction and its position relative to the meibomian gland orifices.

  • Consider imaging studies as appropriate.

History of the Patient

Symptoms of eyelid disease may be vague and nonspecific. While the clinician is collecting the history of the present illness, he or she will find it helpful to watch for unconscious behaviors that may be indicative of an underlying malady. These include eye rubbing, scratching, wiping of excess tears, or decreased orbicularis oculi function.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here