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

Objective:

To highlight the importance of upper lid eversion in ocular examinations for diagnosing ocular and systemic conditions, ultimately improving patient outcomes.

Approach:

Key Findings:

Failure to examine the upper lid can lead to missed diagnoses of ocular and systemic conditions, including those related to systemic diseases like Sjögren syndrome.
Upper lid eversion helps identify meibomian gland dysfunction (MGD) and lid wiper epitheliopathy (LWE), which are critical for managing dry eye symptoms.
Conditions like giant papillary conjunctivitis can be detected through upper lid examination, especially in contact lens wearers.

Interpretation:

Routine upper lid eversion is essential for a thorough ocular surface examination and can significantly impact patient management and outcomes by allowing for early detection of conditions.

Limitations:

Underutilization of upper lid eversion may lead to missed diagnoses, particularly in patients with systemic conditions.
Not all clinicians may be trained or familiar with the technique, which can hinder its implementation in practice.

Conclusion:

Incorporating upper lid eversion into standard ocular examinations can enhance the detection of various ocular conditions, improving patient care and emphasizing the need for clinician education on this technique.