Pull the lower eyelid down with the middle finger Place the index fingertip on the lower edge of the lens Slide the lens down onto the sclera and pinch the lens slightly between the thumb and index finger lifting it off of the globe “Lost” Contact Lens Patients may be uncertain whether their lens is hidden under a lid, remains on the cornea, or is truly off the eye As with all other eye examinations, begin the evaluation with an assessment of visual acuity Then inspect the eye for the contact lens Although transparent, lenses are usually seen easily as a fine line on the sclera several millimeters peripheral to the limbus If the lens is not evident on initial inspection, evert the eyelids (see Procedure in Eversion of the Eyelids section) If the lens is still not visible, place a drop of topical anesthetic in the eye if not already applied Instruct the patient to look downward toward his/her chin, and sweep over the upper fornix gently with a moistened cotton-tipped applicator If the lens remains elusive and the patient is insistent that it is still in the eye, a fluorescein examination may be performed after explaining that the dye will permanently stain a soft contact lens If the contact lens is still not found, reassure the patient that a thorough examination has not located the missing lens Be sure to check that the patient has not inadvertently placed one contact over the other in the opposite eye NASAL CAUTERIZATION Indications Epistaxis recalcitrant to conservative management with the application of a topical vasoconstrictor and manual pressure Contraindications Bleeding diathesis (e.g., hemophilia, thrombocytopenia) Prior nasal cauterization within the past to weeks Complications Septal perforation Staining of the external nose or upper lip with the use of silver nitrate Secondary bacterial infection of the cauterized area Procedure The patient should be sitting or lying in a supine position and, if necessary, manually restrained; distraction techniques, anxiolysis, or procedural sedation