A.

Inspect the Eyelids and Eyelashes

Position
Appearance
Turnings
Color
Swelling
Lesions
Discharges
 The upper lid margin should be
EYELIDS Normal: between the upper margin of
the iris and the upper margin of
the pupil.

The lower lid margin rests on the

lower border of the iris.

No white sclera is seen above or

below the iris.

Palpebral fissures may be

horizontal.

A. Position and width of

palpebral fissures
 Abnormal Findings

PTOSIS

Drooping of the upper lid may be

attributed to oculomotor nerve
damage, myasthenia gravis, weakened
muscle or tissue or a congenital
disorder
B. Assess ability of eyelids to close

The upper and lower lids close

easily and meet completely
when closed

Failure of the lids to close completely

puts client at risk for corneal damage
C. Note the position of the eyelids in comparison with the eyeballs

Normal:

The lower eyelid is upright with no

inward or outward turning.

Eyelashes are evenly distributed and

curve outwards along the lid margins
 ABNORMAL FINDINGS
ECTROPION
An inverted lower eyelid, that results in the
exposure and drying of the conjunctiva
interfering with the normal tear drainage.
ENTROPION
Inverted lower lid which may cause pain
and injure the cornea as the eyelash
brushes against the conjunctiva and
cornea.
 Xanthelasm
Raised yellow plaquesalocated most often near the inner canthus,
normal variations associated with aging and high lipid levels.
 D. Observe for redness, swelling, discharges or lesions
D

Skin on both eyelids is without redness, swelling or lesion

 ABNORMAL FINDINGS

Blepharitis
Crusting or redness along the lid margins
caused by Staphylococcus aureus

Hordeolum

An infection of the hair follicle causing

redness, swelling and pain
 CHALAZION OR CYSTS

An infection of the meibomian

gland (located in the eyelid) that
produces swelling of the lid,
moderate redness, but minimal
pain
E. Observe the position and alignment of the eyeball in the eye
socket

Eyeballs are symmetrically aligned in sockets without protruding or

sinking
 ABNORMAL FINDINGS

XEROPHTHALMUS
Protrusion of the eyeballs with the
lid margins retracted

Sunken appearance of the eyes

 E. Inspect the bulbar conjunctiva & sclera

Clear, moist and smooth. Underlying structures are clearly

visible. Sclera is white.
ABNORMAL FINDINGS

CONJUNCTIVITIS

PINGUECULA
Yellowish nodules on the bulbar
conjunctiva that are common in
older adults
 EPISCLERITIS

A local, non-infectious inflammation

of the sclera
 F. Inspect the palpebral conjunctiva

NORMAL: Free of swelling, foreign bodies or trauma

 Ask the client to look down with
the eyes slightly open.

Gently grasp the client’s upper

eyelashes and pull the lid downward.

Place a cotton tipped applicator app.

1 cm. above the eyelid margin and
push down with the applicator while
still holding the eyelashes

Hold the eyelashes against the upper

ridge of the bony orbit just below
the eyebrow, to maintain the everted
position of the eyelid.
EVERTING THE EYELID Normal : Conjunctiva is free of swelling, foreign
bodies or trauma.
 G. Inspect the lacrimal meatus

NORMAL : No swelling or redness should appear over areas of the

lacrimal gland. The puncta is visible without swelling or redness and
is turned slightly toward the eye
Swelling may be caused by
blockage, infection or
inflammatory condition

Redness or swelling around

the puncta may indicate an
infectious or inflammatory
condition.

Excessive tearing may indicate a nasolacrimal sac obstruction

 H. Palpate the lacrimal apparatus

Put on disposable gloves

to palpate the naso lacrimal
duct to assess for blockage.

Normal : No drainage should be noted from the puncta