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CASE REPORT
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 68-70

A 28-Year-old male with anterior ectopic cilia and hypermetropic anisometropic amblyopia


Department of Ophthalmology, HIMSR, Jamia Hamdard, New Delhi, India

Date of Web Publication7-Mar-2019

Correspondence Address:
Hina Kauser
Rz904/24, Flat 202, Tughlakabad Extension, New Delhi - 110 019
India
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DOI: 10.4103/sjopthal.sjopthal_16_18

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  Abstract 


Only few cases of Eptopic cilia have been reported in literature. Anterior ectopic cilia cause no apparent ocular symptoms and can be surgically excised for cosmetic improvement. We report a case of a 28-year-old male with anterior ectopic cilia in association with hypermetropic anisometropic amblyopia. Only 15 cases of anterior ectopic cilia have been reported in literature. Few of them were associated with some conditions such as choristoma, aberrant lacrimal glands, atopic eczema, nail–patella syndrome, and hypochromic nevus. To the best of our knowledge, this is the first reported case of anterior ectopic cilia associated with hypermetropic anisometropic amblyopia. No underlying common causative disorder became evident. The observed association was considered as coincidental.

Keywords: Amblyopia, anisometropia, ectopic cilia, eyelids


How to cite this article:
Kauser H, Kapoor M. A 28-Year-old male with anterior ectopic cilia and hypermetropic anisometropic amblyopia. Sudanese J Ophthalmol 2018;10:68-70

How to cite this URL:
Kauser H, Kapoor M. A 28-Year-old male with anterior ectopic cilia and hypermetropic anisometropic amblyopia. Sudanese J Ophthalmol [serial online] 2018 [cited 2019 Sep 20];10:68-70. Available from: http://www.sjopthal.net/text.asp?2018/10/2/68/253678




  Introduction Top


Ectopic cilia of the eyelid can occur in two forms – (1) anterior ectopic cilia situated externally in the lateral aspect of the upper eyelid skin, away from the margin[1],[2],[3] and (2) posterior ectopic cilia emerging in the mid-palpebral (tarsal) conjunctiva typically as a single hair.[4],[5] The eyelash in posterior type can be fully exposed or covered by overlying conjunctiva.[4] The anterior ectopic cilia are usually asymptomatic, but the posterior ectopic cilia cause corneal irritation. Surgical excision is the treatment of choice because of corneal irritation in posterior type and cosmetic appearance in anterior type.


  Case Report Top


A 28-year-old male was seen in the ophthalmology outpatient clinic at Hamdard University Hospital, with a chief complaint of diminution of vision in the right eye and a tuft of hair on the lateral side of the upper lid of the right eye. He noticed blurring of vision in his right eye accidentally when he closed the left eye 1 day while doing computer work. The diminution of vision was painless not associated with redness and watering. The hair tuft had been present since childhood but was asymptomatic. The patient did not experience any irritation, swelling, or discharge from the area. There is no positive family history of any ocular disease. Dermatological examination showed a protruded hair tuft composed of approximately 25 hairs on the right eyelid which was 4 mm above the lateral eyelid margin [Figure 1] and [Figure 2]. The hairs were similar to the lashes emerging from the lash line. On palpation, the tuft was adhered to the underlying tarsal plate projecting freely through the skin of the upper eyelid. No tears or sebum or any type of secretion was seen at the site of tuft of hairs. Eversion of the lid showed normal palpebral conjunctiva.
Figure 1: Ectopic cilia

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Figure 2: Tuft of at least 25 hairs above the eyelid margin

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Visual acuity in the right eye was finger counting at 1 m, and left eye was 6/6. There was no squint and ocular movements were normal. Slit-lamp and fundus examination were normal. There was no difference in corneal diameters between both eyes (measured with calliper). The refraction and the radius of the anterior corneal curvature were measured using an autorefractokeratometer. The cycloplegic refractive power was + 8Dsph + 1.25 D cylAx 130° (right eye) and + 0.25Dsph + 0.5 DcylAx 110° (left eye).

The difference in refraction in two eyes was + 8.125D. Best-corrected visual acuity in the right eye was finger counting at 1 m and that in the left eye was 6/6. Keratometry: K horizontal/Kvertical (Right eye) is 41.75/42, K horizontal/Kvertical (Left eye) is 41.25/41.5. Results of A-Scan were as follows: smaller axial length in the right eye: Axial length (mm) – right eye 20.15 and left eye 22.98; anterior chamber depth (mm) – right eye 2.48 and left eye 2.59; and lens thickness (mm) – right eye 4.5 and left eye 4.6.

He was diagnosed as a case of ectopic cilia with hypermetropic anisometropic amblyopia right eye. As vision was normal in one eye and there was no esotropia, the amblyopia remained unnoticed. Visual prognosis was explained, and surgical excision of ectopic cilia was suggested. The patient did not want surgical correction because he did not have any complaints but was more worried for diminution of vision. The co-occurrence of ectopic cilia with hypermetropic anisometropic amblyopia is extremely rare. The present case has been reported because ectopic cilia itself is a very rarely seen entity and no case has been reported in association with hypermetropic anisometropic amblyopia.


  Discussion Top


Ectopic cilia are rarely found in humans, but they have been reported in the veterinary literature.[6] Ectopic cilia can either arise from the anterior or the posterior surface of the tarsal plate.[4],[7] The anterior ectopic cilia are usually located on the lateral quarter of the upper eyelid and associated with the presence of apocrine sweat glands. They are usually unilateral and congenital in onset, without a known family history of similar lesions.[7] The supero-temporal position of hair in the lateral third of the upper eyelid corresponds embryologically to the watershed area between two angiosomes or vascular supplies, the peripheral territories of the facial and superficial temporal arteries, where the type 9 facial cleft of Tessier also occur.[7] Posterior ectopic cilia are usually located in the mid-palpebral (tarsal) conjunctiva typically as a single hair which can be fully exposed or covered by overlying conjunctiva.[4]

The origin of ectopic cilia is still not clear. While anterior ectopic cilia are congenital, posterior ectopic cilia are usually acquired due to the chronic inflammation.[5] The deformity of the upper lid meibomian glands, with complete or partial replacement of these glands with skin glands, was considered to be the embryologic origin of the anterior ectopic cilia.[1] While others reported that the origin of ectopic eyelid cilia is from the eyelid skin and not from the metaplastic Meibomian glands of the tarsus, as the hair bulbs in anterior ectopic cilia were located in dense fibrous tissue at the level of the lower dermis but above the orbicularis striated muscle and the tarsus.[8]

Sebum accumulation and tears were reported at the base of ectopic cilia in literature.[9],[10]

The ectopic cilia are often associated with distichiasis, choristoma, atopic eczema, nail-patella syndrome, and hypochromic nevus.[11],[12],[13],[14] However, in our case, we could not find any of these abnormalities and any secretion such as sebum and tears, but it is associated with hypermetropic anisometropic amblyopia. No underlying common causative disorder became evident. The observed association was considered as coincidental.

Surgical removal of ectopic cilia is the treatment of choice. Recurrence can occur at the original site due to an incomplete surgical excision.

Only 15 cases of anterior ectopic cilia were documented in the literature.[14] Till date, no case of anterior ectopic cilia with hypermetropic anisometropic amblyopia has been reported. To our knowledge, this is the first case of anterior ectopic cilia associated with hypermetropic anisometropic amblyopia, which was considered as coincidental finding.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen TS, Mathes EF, Gilliam AE. ''Ectopic eyelashes'' (ectopic cilia) in a 2-year-old girl: Brief report and discussion of possible embryologic origin. Pediatr Dermatol 2007;24:433-5.  Back to cited text no. 1
    
2.
Baghestani S, Banihashemi SA. Ectopic cilia in a 14-year-old boy. Pediatr Dermatol 2011;28:55-6.  Back to cited text no. 2
    
3.
Nakra T, Blaydon SM, Durairaj VD, Shinder R. Congenital upper eyelid ectopic cilia. J Pediatr Ophthalmol Strabismus 2011;48:e16-8.  Back to cited text no. 3
    
4.
Jain SC, Saini VK. Bilateral ectopic cilia (a case report). Indian J Ophthalmol 1985;33:67-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Hase K, Kase S, Noda M, Ohashi T, Shinkuma S, Ishida S, et al. Ectopic cilia: A histopathological study. Case Rep Dermatol 2012;4:37-40.  Back to cited text no. 5
    
6.
Helper LC, Magrane WG. Ectopic cilia of the canine eyelid. J Small Anim Pract 1970;11:185-9.  Back to cited text no. 6
    
7.
MacQuillan A, Hamilton S, Grobbelaar A. Angiosomes, clefts, and eyelashes. Plast Reconstr Surg 2004;113:1400-3.  Back to cited text no. 7
    
8.
Jakobiec FA, Yoon MK. Histopathologic proof for the origin of ectopic cilia of the eyelid skin. Graefes Arch Clin Exp Ophthalmol 2013;251:985-8.  Back to cited text no. 8
    
9.
Chappell MC, Spencer W, Day SH, Silkiss RZ. Congenital ectopic cilia of the upper eyelid. Ophthalmic Plast Reconstr Surg 2011;27:e42-4.  Back to cited text no. 9
    
10.
Gordon AJ, Patrinely JR, Knupp JA, Font RL. Complex choristoma of the eyelid containing ectopic cilia and lacrimal gland. Ophthalmology 1991;98:1547-50.  Back to cited text no. 10
    
11.
Bader A. Congenital aplasia of the Meibomian glands of the lower eyelid. Albrecht Von Graefes Arch Ophthalmol 1950;150:411-3.  Back to cited text no. 11
    
12.
Möhrenschlager M, Köhler LD, Ring J. Ectopic cilia in a Caucasian girl with atopic eczema. Acta Derm Venereol 1998;78:146-7.  Back to cited text no. 12
    
13.
Edmunds MR, Kipioti A, Colloby PS, Reuser TT. A case of ectopic cilia in nail-patella syndrome. Int Ophthalmol 2012;32:289-92.  Back to cited text no. 13
    
14.
da Fonseca FL, Yamanaka PK, Lima PP, Matayoshi S. A 6-year-old girl with ectopic cilia and hypochromic nevus. Clin Ophthalmol 2014;8:1259-61.  Back to cited text no. 14
    


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