Sir,

Eyelashes have been documented as growing in anomalous lid locations including meibomian gland orifices1 and burrowing beneath eyelid tissues—cilium incarnatum internum and externum.2 A paucity of literature exists regarding ectopic lashes, particularly conjunctival cilia. Scarring of the mobile bulbar and forniceal conjunctiva encourages the formation of blind pockets in which lashes can become trapped.3 We describe a case of cilia originating beneath the bulbar conjunctiva in a setting of previous intraocular surgery.

Case report

An 81-year-old lady attended outpatients in August 2004, describing recurrent foreign body sensation in the right eye. Past history included surgery for right total retinal detachment and bilateral YAG laser iridotomies for angle closure glaucoma. Best-corrected acuity was counting fingers right, 6/18 left. Slit-lamp examination revealed ectopic eyelashes originating from beneath the healed conjunctival peritomy made at the previous retinal surgery. There were around 13 lashes near the temporal limbus, approximately 10 had their bases inferiorly, extending superiorly, the remaining ones started superiorly and projected downwards. One lay horizontally (Figure 1). The overlying conjunctiva was mildly injected. Lid position and cornea appeared normal, and other than nuclear sclerotic cataract, there was no pathology of the left eye.

Figure 1
figure 1

Subconjunctival cilia near temporal limbus of right eye.

Full size image

Hospital records revealed that 5 days prior to retinal surgery in 1995, the patient had fallen and preoperatively had periorbital ecchymoses. A single cilium beneath the bulbar conjunctiva was first observed in the patient's right eye in November 1996 and epilated. Following this, she presented at yearly intervals in September 2001, October 2002, and October 2003, with irritation of the right eye. Each time, multiple subconjunctival lashes in the temporal aspect were epilated.

In October 2004, the patient underwent conjunctivoplasty with en bloc removal of the lashes and cautery to the underlying sclera. So far, there has been successful resolution of symptoms.

Comment

Ectopic cilia are rarely encountered. Some reports describe congenital lash tufts in the temporal aspects of upper eyelids.4, 5 Eyelashes have also been reported emerging from the iris de novo and following trauma.6 The aetiology of the former remains uncertain, posteriorly located dermoids or teratomas have been postulated. In the latter case, displacement of lash follicles is felt to be causative.6

The few reports of subconjunctival cilia mainly concern single lashes1, 7, 8 and include granuloma formation secondary to conjunctival embedding of a cilium7 and dermolipomas allowing lash ingress to the conjunctiva.1 To the authors’ knowledge, there is only one other published report of ectopic cilia in the setting of previous intraocular surgery, that patient having had retinal surgery, pterygium removal, and cataract extraction.3 In our case, given that the ectopic cilia were first observed 1 year following surgery, it is likely that displacement occurred perioperatively. The mechanism may have been a cumulative effect of the fall suffered by the patient preoperatively, and surgery. Following traumatic displacement of lash tissue to the conjunctiva, the peritomy folds gave recess for any dislodged follicles. The yearly recurrence contrasts with trichitic lash regrowth. This unusual case illustrates the need for such patients to be reviewed for recurrence necessitating surgical intervention.