Correspondence Address: Dr. Ankita Aishwarya Department of Ophthalmology, Gajra Raja Medical College (G.R.M.C), Room No. 34, Senior Girls Hostel, Gwalior, Madhya Pradesh - 474 001 India
Source of Support: None, Conflict of Interest: None
In 19th century, sir Louis-Auguste Desmarres, a French ophthalmologist, introduced Desmarres-curved lid retractor.[1] It is used to retract upper lid during examination of eyeball and for double eversion of upper lid to examine superior fornix.[2] Barraquer eye speculum is used to keep lids apart during any intraocular procedure.[2]
In 2008, a paper clip usage was demonstrated for retraction of edematous lids, but double eversion of lid is not possible with this instrument.[3] In 2012, a case was reported by Canadian dental association wherein a dentist lost total sight in one eye after splashing calcium hydroxide in her left eye due to ineffective removal of calcium hydroxyl apatite from recess of the eye.[4] Chemical burns are characterized by ongoing tissue destruction for as long as the inciting agent is present.[5],[6],[7] Thus, the earliest removal of the inciting agent is crucial in management of chemical injuries. We hereby describe an easy and quick technique on how to use wire eye speculum as a wire lid retractor for double eversion of lid.
Technique
The wire lid retractor is made by bending the universal wire eye speculum from its apex at 180° as shown [Figure 1]. It is easily accomplished due to the malleable property of wire speculum.
Figure 1: (a) Normal Barraquer lid speculum with blades facing outward. (b) Bending 180° at the apex of speculum. (c) Speculum with blades facing inward
The wire lid retractor can be used in two ways depending on the clinical situation:
For mild lid edema: place the upper arm of retractor on upper eye lid and evert the eyelid onto it for single eversion and turning the retractor handle further for double eversion [Video 1].
For moderate lid edema: after instillation of paracaine drop, hold upper lid with the help of both the arms just like a forceps and evert the lid.
Discussion
The wire lid retractor can be used in different clinical conditions, including chemical injury, foreign body lodgment, intraocular trauma, concretions, and ocular infection. The upper lids could always be everted without exerting pressure on globe in cases of trauma. A word of caution is that this device should not be used in patients with lid defects and tense swollen lids.
The wire lid retractor has following applications:
In ocular chemical injuries:
to examine the fornices and conjunctiva,
to remove lime particles effectively and immediately under slit lamp, and
To examine palpebral conjunctiva and superior fornix in adult and infant [Figure 3] in cases of foreign body lodgment, intraocular trauma, and ocular infection.
Figure 3: Localize lesion in palpebral and bulbar conjunctiva in adult and infants, respectively
Barraquer wire eye speculum can also be used as a wire lid retractor by slight modification. The wire lid retractor is easy to make, learn, and use. Though not self-retaining, it exerts no pressure on the globe. It can be used in sitting or supine position. It can be used with slit lamp or under operating microscope. Thus, it is a useful device for evaluation of lid pathologies as an office procedure and in the operating room. It is a simple technique for converting a wire speculum into a device used for eversion/double eversion of eyelid.
Declaration of patient consent
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