lid clinical tests

1-Upper lid elevation test(Levator action test)

Aim: rough method to test for levator action (supplied by 3^rd nerve)

Steps:

1-Ask the patient to look in 1ry position

2-Press on eyebrow/s against bone firmly (to avoid the action of frontalis muscle)

3-Ask the patient to look upwards

Results:

*If there is any degree of upper lid elevationà levator action is present

*If no elevation at allàComplete loss of levator action

Oral questions:

*What is the accurate method to test levator action.

*Muscles responsible for lid elevation & related nrves

*Significance of testing levator action

*Ptosis

 

2-Lid closure test(Orbicularis action test)

Aim: to test for orbicularis oculi muscle (supplied by 7^th nerve)

Steps:

1-Ask the patient to close his eye firmly

2-Try to open his eye gently by index & thumb fingersàfeel the power of lid closure

Results:

*If the patient can not close his eye at allà Complete loss of orbicularis action(severe degree of paralytic lagophthalmos)

*If the patient can close his eye but the eyelids can be opened easily by fingersàweakness of the orbicularis action(Mild degree of paralytic lagophthalmos)

*If the patient can close his eye & the eyelids can not be opened by fingersàNormal orbicularis action

Oral questions:

*lagophthalmos

 

3-Upper lid evertion test

Aim: to examine the upper palpebral conjunctiva & upper fornix

Types of U.L evertion:

a)-Single evertion: done to show the upper palpebral conjunctiva

b)-Double evertion: done by using lid evertor or retractor to show the upper fornix

Steps of single evertion of U.L:

1-Ask the patient to look downwards

3-Put your index finger above the tarsus & your thumb below the lashes & upper lid margin(catching them)

3-Evert the upper lid by rotating the lashes & upper lid margin over the index finger

4-The index finger may be replaced by a glass rod covered with a piece of cotton

Oral questions:

*What are the normal structures seen in single evertion

* What are the possible lesions seen in single evertion

*What are the possible lesions seen in double evertion