Several eye lid retractors are also available The most useful for the emergency physician is the Desmarres retractor An alternative is the Eyegenie eyelid retractor which has the advantage of having both upper and lower lid retractors on a single instrument Place a drop of topical anesthetic on the bulbar conjunctiva, and then slip the blade of the retractor under the lid margin and exert gentle traction upward and/or downward as indicated, as well as away from the globe The Desmarres retractor in Figure 130.17 is demonstrating both eyelid eversion and gentle retraction If only one retractor is to be used, it is most helpful to retract the upper eyelid, which often overhangs the lower lid when both are swollen