Determining the Significance of Abnormalities of the Outer Eye and Cornea

Appearance of the eye and adnexa
The general appearance of the eye and the adnexa (globe, eyelids, lacrimal apparatus, orbit and paraorbital areas) should be assessed and the symmetry of each side compared. The angle of the upper eyelashes to the cornea should be examined. Normally they should be at almost 90 degrees to the cornea.

The eyelids
The margins, outer and inner surfaces of the upper and lower eyelids should be examined. The position of the eyelashes on the upper lid is noted. Nonpigmented eyelids should be examined carefully as they are more susceptible to squamous cell carcinoma. The outer surface of the third eyelid can be easily protruded and examined by applying thumb pressure on the dorsolateral globe through the upper eyelid. The inner surface of the third eyelid is examined by everting it using atraumatic tissue forceps following the application of a local anaesthetic. [...]