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   Table of Contents      
PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 3  |  Page : 391-392

Wire lid retractor – A new use of wire eye speculum


Department of Ophthalmology, Gajra Raja Medical College (G.R.M.C), Gwalior, Madhya Pradesh, India

Date of Submission04-Jul-2018
Date of Acceptance09-Nov-2018
Date of Web Publication18-Feb-2019

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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1119_18

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  Abstract 


Keywords: Chemical injury, double eversion, eye speculum, eyelid retractor


How to cite this article:
Aishwarya A, Gupta P, Tiwari US. Wire lid retractor – A new use of wire eye speculum. Indian J Ophthalmol 2019;67:391-2

How to cite this URL:
Aishwarya A, Gupta P, Tiwari US. Wire lid retractor – A new use of wire eye speculum. Indian J Ophthalmol [serial online] 2019 [cited 2019 May 24];67:391-2. Available from: http://www.ijo.in/text.asp?2019/67/3/391/252398



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 Top


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

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The wire lid retractor can be used in two ways depending on the clinical situation:

  1. 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].




  2. 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 Top


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:

  1. In ocular chemical injuries:


    • to examine the fornices and conjunctiva,
    • to remove lime particles effectively and immediately under slit lamp, and
    • to swipe and wash fornices [Figure 2].
    Figure 2: Double eversion of upper lids in chemical injury

    Click here to view


  2. To remove concretions under slit lamp.
  3. 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

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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

We certify that we have obtained all appropriate consents from patient. Patient has given consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
wikipedia/Louis-Auguste_Desmarres https://en.wikipedia.org/wiki/Louis-Auguste_Desmarres.  Back to cited text no. 1
    
2.
Khurana AK, Khurana AK, Khurana B. Comprehensive Ophthalmology. 4th ed. New Delhi: New Age; 2010. 575-7p.  Back to cited text no. 2
    
3.
Cheng LHH, Kumar P. Retraction of oedematous eyelids with paper-clips. Ann R Coll Surg Engl 2008;90:253.  Back to cited text no. 3
    
4.
Lipski M, Buczkowska-Radlińska J, Góra M. J Can Dent Assoc 2012;78:c57.  Back to cited text no. 4
    
5.
Sykes RA, Mani MM, Hiebert JM. Chemical burns: Retrospective review. J Burn Care Rehab 1986;7:343-7.  Back to cited text no. 5
    
6.
Doull J. Toxicology: The Basic Science of Poisons. 2nd ed. Macmillan; 1980. p. 35.  Back to cited text no. 6
    
7.
Saydjari R, Abston S, Desai MH. Herndon DN. Chemical burns. J Burn Care Rehabil 1986;7:404-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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