If the patient is unsuccessful in correcting the problem and presents to the emergency department or the physician's office, a small pediatric Desmarres retractor may be used to engage the eyelid to pull it over the globe. Frequently, however, the curved blade of the Desmarres retractor cannot get under the tight and retracted upper lid. To circumvent this, a large-sized paper clip may be used. The paper clip is spread apart to form a right angle, similar to the configuration of a handheld laryngoscope. The wider and longer horizontal arm of the paper clip is bent slightly and the sharp end of the wire is bent upward further to avoid inadvertent contact with the globe (Figure 2). Topical anesthetic is applied to the posed globe before attempting extrication. The physician positions the horizontal arm on top of the globe and introduces it between the upper lid margin and superior rectus. The superior rectus muscle insulates the tip of the paper clip from accidental contact with the optic nerve. Once the tip of the clip is under the eyelid, the globe is depressed with the ring finger of the hand holding the clip, while the examiner simultaneously pulls the eyelid skin upward with the fingers of the other hand. The upper eyelid glides over the curved arm of the paper clip. When the eyelid passes over the equator, the patient is instructed to look upward, thus pulling the globe behind the eyelid. In this maneuver, the paper clip functions like a shoehorn in guiding the lid over the subluxed globe. This simple instrument has been successful in extricating the retracted upper eyelid from behind the globe.