Pseudo-cilium of the punctum: an unusual foreign body

Abstract

A woman in her 40s presented to the ophthalmology outpatient department at AIIMS, Bilaspur, India, with foreign body sensation and watering in her left eye. There was no history of trauma, surgery, medication, or systemic disease. On examination, visual acuity was 6/6 in each eye. Intraocular pressure was normal. On slit-lamp examination, mild redness and chemosis of the nictitating plica semilunaris membrane and adjacent bulbar conjunctiva were present, and there was an inward-directed cilium from the upper eyelid (A, slit lamp photograph under diffuse illumination and low magnification) rubbing the conjunctiva, with localized injection. On lifting the upper eyelid to further evaluate, a cilium was observed emerging from the upper punctum, rubbing against the bulbar surface (B, under high magnification; same eyelash seen on everting lid margin). There was no associated inflammation of the punctum, skin or conjunctiva overlying the canaliculi or sac. The eyelash was removed effortlessly using epilation forceps following application of topical proparacaine 0.5% ophthalmic solution. The smooth extraction of the hair follicle indicated that it was not firmly rooted but merely lodged within the lacrimal punctum. This case highlights the importance of a careful slit-lamp examination of eyelid margins and ocular surface in areas of localized redness in patients presenting with the feeling of foreign body sensation, epiphora, or irritation.