Conjunctival Pallor on Physical Exam

After gently pulling down the patient's lower lid (top), the clinician observes the lid's inner surface, comparing the color of the lid margin (its rim) with the conjunctival surface nearer to the globe. In patients without anemia (bottom left), there are two zones of color: a reddish color at the rim (due to its prominent vascular supply) and a contrasting paler color nearer to the globe (from prominent lymphoid tissue). In patients with anemia (bottom right), the entire inner surface of the lower lid has a pale color (conjunctival rim pallor).



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