Everting the upper lid

In this Optometric Management feature, Dr. Mile Brujic, OD, FAAO, makes the case that upper lid eversion deserves a place in every comprehensive ocular examination. Drawing on a 2025 peer-reviewed study published in Cornea, he explains that failure to examine the superior palpebral conjunctiva can lead to overlooked diagnoses of both ocular and systemic conditions, resulting in delayed intervention and less favorable patient outcomes.

The article walks through several clinical scenarios where upper lid eversion proves essential. For meibomian gland dysfunction, Dr. Brujic highlights the importance of evaluating upper lids in contact lens wearers, noting the association between upper lid gland tortuosity, plugging, meibum quality, and contact lens dropout. He also addresses lid wiper epitheliopathy — a condition commonly linked to dry eye that can be missed entirely without upper lid eversion — as well as conjunctival issues including giant papillary conjunctivitis, foreign bodies, and concretions.

For clinicians looking to strengthen their diagnostic workflow, this article provides a concise, evidence-backed overview of the conditions that upper lid eversion can reveal and why routine examination of this area should be standard practice.