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Lid eversion is an essential component of contact lens aftercare. Hence, this study determined the best method of lid eversion based on three criteria: comfort, speed of administration and the area of the palpebral conjunctiva exposed.
Twenty-five participants (aged 20-34) had 6 different techniques applied in random order by the same clinician on two separate occasions: three involving a cotton bud placed on the extended upper eyelid either centrally, at the top of the tarsal plate or off-centre; one using the wooden end of the bud placed at the top of the tarsal plate; one using the clinician\'s index finger to evert the lid; and one using a silicone rubber, finger-shaped substitute. The participants judged the degree of discomfort of each technique on a visual analogue scale. The time to complete the task was timed with a stop-watch and the area of exposed palpebral conjunctiva was captured with a digital slit lamp and assessed using image analysis.
There was no difference between the initial lid eversion or subsequent repeat in terms of comfort (F = 0.304, p = 0.586), time to complete (F = 3.075, p = 0.092) or area exposed (F = 2.311, p = 0.142). Lid eversion using fingers alone or the silicone substitute everter were similar in comfort (p = 0.312), being the most comfortable methods, with off-centre cotton bud eversion or the wooden end of the cotton bud the least comfortable techniques (F = 17.480, p < 0.001). The quickest method to perform was the wooden end of the cotton bud, followed by the silicone everter (F = 17.522, p < 0.001). The area of exposed palpebral conjunctiva was greatest using the silicone everter (F = 28.199, p < 0.001).
Lid eversion had repeatable results, with the silicone everter placed at the top of the tarsal plate the most comfortable for the patient, quick to perform and exposed a greater area of tarsal plate than other techniques and therefore is recommended to clinicians.

Purpose: The first aim of this study was to compare inferior tear meniscus height (TMH) measured by keratography and swept-source optical coherence tomography (OCT). Effect of locations of fluorescein instillation and subjects\' subjective sensation, and the TMH results were also investigated.Methods: Forty-one eyes from 41 healthy adults had TMH randomly measured by keratography (K5M, Oculus, Germany) and swept-source OCT (Casia SS-1000, Tomey Corp, Japan) at baseline, followed by touching either the inferior bulbar or inferior palpebral conjunctiva, randomly assigned, with a moistened fluorescein strip. Two-way analysis of variance (ANOVA) was used to compare TMH obtained from the two devices and three measurement conditions. Subjective sensation of conjunctival touch was obtained through a 4-point scale with zero representing no sensation, and one to three representing ocular sensation in an ascending order.Results: Two-way ANOVA revealed no significant difference in TMH between keratography and swept-source OCT (Factor (devices): F = 0.579, p = .451) while there was a significant difference among fluorescein instillations (Factor (conditions): F = 10.146, p < .001). Baseline TMH was around 0.25 mm, and increased to around 0.28 mm after instillation of fluorescein sodium. Ocular sensation was similar between the two conjunctival touch, and TMH was not significantly associated with ocular sensation.Conclusions: Keratography and swept-source OCT provided similar TMH results. Applying fluorescein sodium through moistened fluorescein strip could over-estimate TMH by around 0.03 mm. Applying moistened fluorescein strip at bulbar or palpebral conjunctival led to similar subjective sensations and did not affect TMH measurement.

A 61-year-old woman with a history of palpebral conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma, treated with rituximab, was referred to the authors\' hospital after follow-up positron emission tomography/computed tomography revealed 18F-fluoro-2-deoxy-d-glucose uptake in a tumor located in the left main bronchus. The diagnosis of MALT lymphoma was made by pathological and immunohistochemical findings homologous to previous palpebral conjunctival lesion via bronchoscopic biopsy. The disease was controlled with rituximab, cyclophosphamide, oncovin, and prednisolone (i.e., R-COP) chemotherapy. Although MALT lymphoma occurs in several organs, metachronous occurrence in the palpebral conjunctiva and bronchus is especially rare, and careful check-up is required to monitor for occurrence of systemic relapse.

OBJECTIVE: To report a case with solitary circumscribed neuroma (SCN) in the palpebral conjunctiva.
METHODS: This is a retrospective observational case report of a 78-year-old female who showed a yellowish, smooth-surface, dome-shaped mass in the right lower palpebral conjunctiva near the punctum. The mass was completely removed under local anesthesia.
RESULTS: Pathological examination revealed that it was composed of benign spindle-shaped cells and tapering nuclei arranged in bundles. Immunocytochemical analyses for the S100, neurofilament, CD34, and epithelial membrane antigens were all positive. These pathological findings were consistent with a SCN. At the 6-month follow-up, there was no evidence of recurrence.
CONCLUSIONS: This is the first case report of SCN in the palpebral conjunctiva. Although SCN had similar clinicopathological features to other benign peripheral nerve sheath tumors, including neurofibroma and schwannoma, immunocytochemical analyses were helpful for correct diagnosis of this case.

OBJECTIVE: To measure the palpebral conjunctival epithelium thickness in young adults with optical coherence tomography (OCT).
METHODS: A Cirrus HD-OCT 4000 system was used to image the superior palpebral conjunctival with the Anterior Segment 5 Line Raster scanning protocol at the central region in 36 male and 26 female subjects aged between 20 and 30 years of age with normal, healthy eyes. The palpebral conjunctival epithelium thickness was measured according to the difference in brightness on OCT between the epithelium and its underlying substantia propria. The measurements were respectively performed in the same subjects by two operators and the Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between two operators.
RESULTS: No difference in the palpebral conjunctival epithelium thickness was found between the males (34.00±5.78 μm) and females (33.67±4.51 μm) (t=0.2425, p=0.8095). The mean values of the superior palpebral conjunctival epithelium thickness from operator 1 and operator 2 were 33.81±5.04 μm and 34.74±4.28 μm, respectively. The analysis of inter-operator variability demonstrated a good agreement between two operators: ICC=0.944, F=17.787, p<0.001; on the Bland-Altman plot, the 95% limits included 100% of differences between the two operators and the maximal difference is 5 μm.
CONCLUSIONS: The palpebral conjunctival epithelium thickness can be measured using OCT with a good repeatability.

Epidermoid cysts are common benign cysts which occur particularly on the skin of the face, neck and upper trunk. Subconjunctival location of these cysts is very rare and, until today, only seen in patients with Gorlin-Goltz syndrome. Histopathological examination of these cysts show similarities with odontogenic keratocysts, a typical clinical manifestation of Gorlin-Goltz syndrome.