Everting the eyelid
- Examination
Turning the upper lid inside out takes seconds and finds hidden foreign bodies, lime particles and papillae. Never done if an open globe is suspected.
See it in 3D: Eyelids
What it is
Eyelid eversion exposes the inner surface of the upper lid (the tarsal conjunctiva), where foreign bodies often lodge and where conjunctival papillae and follicles are seen. Single eversion shows the tarsal plate; double eversion, with a lid retractor, reaches the upper fornix and is needed after chemical injuries to remove trapped particles. The lower lid is examined simply by pulling it down.
Normal values and scales
- Large papillae on the upper tarsus: allergic conjunctivitis or a reaction to contact lenses (giant papillary conjunctivitis).
- Follicles on the tarsus: viral or chlamydial conjunctivitis.
- Scarring of the upper tarsus: trachoma.
- Retained particles in the fornix after a chemical splash keep releasing the chemical.
How it is done
- Instil an anaesthetic drop if the eye is painful, and explain that the manoeuvre is brief.
- Ask the patient to keep looking down throughout.
- Grasp the upper lashes gently and pull the lid down and slightly away from the eye.
- Place a cotton bud or the finger on the skin about a centimetre above the lid margin, at the upper edge of the tarsal plate.
- Fold the lid up over the bud so it turns inside out, and hold it against the brow by the lashes.
- Inspect and remove any foreign body with a moist swab; for the fornix, use a lid retractor (double eversion).
- Ask the patient to look up to return the lid to its place.
How to interpret it
- Vertical scratches on the cornea with fluorescein point to a particle under the upper lid.
- A scarred upper tarsus with inturned lashes in a patient from a rural area suggests trachoma.
- Eversion presses on the globe: it is avoided when an open globe is possible.
Next step / Initial management
- Foreign body removed: topical antibiotic and review if symptoms persist after 24 to 48 hours.
- Chemical injury: double eversion and fornix sweep during irrigation.
- Giant papillae in a lens wearer: stop lens wear and refer to ophthalmology or optometry.
- Tarsal scarring with trichiasis: ophthalmology for lid surgery and public health notification where trachoma is endemic.
Test yourself
Think of the answer, then tap the question to see it.
Where is the cotton bud placed to evert the upper lid?
On the skin about a centimetre above the lid margin, at the upper edge of the tarsal plate, while the patient looks down.
When is double eversion needed?
After chemical injuries, to expose the upper fornix and remove trapped particles.
What does scarring of the upper tarsus with inturned lashes suggest?
Trachoma.
Connections
See it in 3D1
The structures of Durgical's 3D anatomy where it is found.
In Pharmacology1
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Corneal Foreign Body Removal (StatPearls Publishing (NCBI Bookshelf), 2023); Ocular Burns (StatPearls Publishing (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.