Brief Communication Delhi Journal of Ophthalmology

DOI : h p://dx.doi.org/10.7869/djo.2012.74 Eyelash in Lacrimal Punctum Rachna Meel MS, Shashi Vashisht MS A 30-years-old male patient presented with watering location, which may be easily overlooked. Eyelashes and foreign body sensation for 3 days. Ocular surface are normally arranged in two or three rows on upper and examination on slit lamp did not reveal any foreign body lower eyelids. They are more numerous on upper eyelid, or cilia. Fluorescein staining revealed scratches on cornea approximately 150 eyelashes being present on upper and near the medial limbus. Examination of the eyelid margin 75 on the lower eyelid. These are regularly shed every 100 revealed an eyelash protruding from the upper punctum to 150 days.1 Normally, shedding of an eyelash does not (the hair bulb was in the canaliculus) (Figure 1). There was cause any symptoms. Sometimes however, an eyelash may no associated infl ammation of the draining canaliculus or settle down in an unusual location after being shed. Such any eyelid disease likely to cause trichiasis. Moreover, the misplaced cilia have been reported in the lacrimal puncta, eyelash could be easily removed with a forceps without the meibomian gland orifi ce, subconjunctival space and even use of any sharp movement that is required for epilation, corneal stroma. The patient usually presents with a history thereby proving that the eyelash was not actually growing of foreign body sensation and watering.2 Unless the treating from the punctum but was just lying there. ophthalmologist is aware that a shed out eyelash may be found at such an unusual location, one may not look for it Discussion or misdiagnose it for an abnormally grown or metaplastic 3 Eyelashes are shed regularly like body hair. Usually eyelash. shed eyelashes do not cause any symptoms. However Once an eyelash is shed onto the external ocular surface, sometimes such cilia may get misplaced and have been it causes foreign body sensation. This causes refl ex tearing reported to end up in the lacrimal puncta, meibomian that carries away the eyelash to the lacus lacrimalis and thus gland orifi ce, subconjunctival space and corneal brings it in close contact with the lacrimal puncta. From stroma. An eyelash when it gets misplaced into the here it may travel into the punctum either due to propelling punctum has the potential to cause additional problems. action of the eyelids or due to negative pressure created in Therfore, it is important to identify shed cilia in this the canaliculus in each blink cycle.2 Once the eyelash enters into the punctum, the barbs on the hair prevent it from being expelled. It can further obstruct the canaliculus, causing epiphora, or cause infl ammation and/or infection, causing canaliculitis or dacryocystitis.3 Eyelashes are reported to enter the upper punctum more frequently than the lower punctum.4,5,6 To conclude, in patients with nonspecifi c eye symptoms, a misplaced eyelash may be the cause which can be easily overlooked and treated inappropriately. Therefore it's important to examine the eyelid margin carefully in such cases.

References

1. Snell RS, Lemp MA. Clinical Anatomy of the Eye. Boston: Blackwell Scientifi c Publications, 1989: 9 2. Gutteridge IF. Curious cilia cases. Clin Exp Optom 2002; 85: 5: 306-8. 3. Taneja S, Arora R, Yadava U. Fingernail trauma causing Figure 1 Clinical photograph of patient’s left eye showing corneal laceration and intraocular cilia. Arch Ophthalmol eyelash protruding from the upper punctum. 1998; 116:530-1. 4. Duke-Elder S. System of Ophthalmology. Vol 13. Dr. Ram Manohar lohia Hospital and PGIMER London: Henry Kimpton; 1974. New Delhi,110001 5. Nagashima K, Kido R. Relative roles of upper and lower lacrimal canaliculi in normal tear drainage. Jpn J Correspondence to : Dr. Rachna Meel Ophthalmol 1984;28:259-62. E-mail : [email protected] 6. Rosen WJ, Rose GE. Intranasal passage of dacryoliths. Br J Ophthalmol 2000; 84:799-800.

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