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eyelids are separated ( Fig. 114.1 ). If the globe cannot be readily viewed using
these techniques, it is safer to refer the patient for an ophthalmology consultation.
Risking the use of a speculum or retractor may upset the patient, raise intraocular
pressure, and contribute to disruption of intraocular contents if an open-globe
injury is present. Even the ophthalmologist may choose to avoid such attempts
and proceed directly to an examination under anesthesia.

Check the Red Reflex
Absence or asymmetry of the red reflex indicates an abnormality to the path of
light into the eye. This abnormality may be at the level of the cornea (e.g., a
contusion or laceration causing edema and clouding) or anterior chamber or
posterior chambers of the eye (e.g., vitreous hemorrhage or inflammation). An
abnormal red reflex requires emergent ophthalmology consultation.

FIGURE 114.1 Opening swollen eyelids manually from the superior and inferior orbital rims.