Everting the Upper Lid

Failure to examine the superior palpebral conjunctiva may lead to overlooked diagnoses of ocular and systemic conditions, resulting in delayed intervention and less favorable patient outcomes.

By
Mile Brujic, OD, FAAO
January 1, 2026
4 min

Optometric Management

At a Glance

Category	Detail
Condition	Meibomian Gland Dysfunction (MGD) and Lid Wiper Epitheliopathy (LWE)
Key Mechanisms	Upper lid eversion allows visualization of the superior palpebral conjunctiva, aiding in the diagnosis of ocular and systemic conditions.
Target Population	Contact lens wearers and non-contact lens wearers with ocular surface symptoms.
Care Setting	Optometric practices and ocular examinations.

Key Highlights

Upper lid eversion is essential for comprehensive ocular examinations.
Failure to examine the superior palpebral conjunctiva can lead to missed diagnoses.
MGD is associated with dissatisfaction in contact lens wearers.
Lid wiper epitheliopathy is linked to dry eye disease and ocular dryness symptoms.
Routine upper lid examination can identify conditions like giant papillary conjunctivitis.

Guideline-Based Recommendations

Diagnosis

Incorporate upper lid eversion in ocular surface examinations to identify MGD and LWE.

Management

Evaluate meibomian gland function in contact lens wearers to prevent dropout.

Monitoring & Follow-up

Regularly assess the upper lid for signs of inflammation, foreign bodies, and meibomian gland health.

Risks

Underutilization of upper lid eversion may lead to delayed diagnoses and suboptimal patient outcomes.

Patient & Prescribing Data

Patients experiencing discomfort with contact lenses or symptoms of dry eye.

Identifying MGD and LWE can guide treatment decisions and improve patient satisfaction.

Clinical Best Practices

Perform upper lid eversion during routine ocular examinations.
Educate patients about the importance of lid health in relation to contact lens wear.
Utilize vital staining to assess lid wiper epitheliopathy.