A Rare Case Report of Posterior Ectopic Cilia in a 41-Year-Old Saudi Male

There is a wide spectrum of cilial anomalies; however, ectopic cilia are the rarest of the cilial anomalies. We report, to the best of our knowledge, the third worldwide case of this eyelid anomaly in the inferior palpebral conjunctiva and the first with a long-term follow-up of 18 months without recurrence following excision. The 41-year-old Saudi male presented with posterior ectopic cilia in the palpebral conjunctiva of the left lower eyelid. This rare anomaly was not associated with other findings. Eighteen months after complete excision of the cilia (along with the adjacent conjunctiva and tarsal plate), there was no recurrence of the ectopic cilia. This case highlights the importance of considering ectopic cilia when patients present with focal punctate keratopathy and the importance of excision of the cilia along with the adjacent conjunctiva and tarsal plate to prevent recurrence.

Bullous Keratopathy in a dog treated with Third Eyelid Flap and Autologous Serum Eye Drops

Background: Bullous Keratopathy (BK) is characterized by decompensation of the corneal stroma resulting in visual impairment by corneal opacity, discomfort, excessive tearing, blepharospasm and pain. The aim of this study was to report a case of BK in a dog and the complete recovery of the ocular structure and visual function, with a third eyelid flap associated with the use of autologous blood serum topically.Case: A 2-year-old Shih Tzu male dog, weighing 4.3 kg, with recurrent bilateral eye discomfort was brought to Ophthalmologist Veterinarian Assistance. The patient had already been seen by other veterinarians, but the signs returned in a short period of time after the prescription was suspended. During physical examination it was observed moderate blepharospasm in the right eye, epiphora in the left eye, and in both eyes was noted exophthalmos, medial corneal entropion, caruncle trichiasis and ectopic cilia in the upper and lower eyelids. Fluorescein test was positive in both eyes, and a large bullous, opaque and gelatinous lesion with irregular appearance was observed occupying a large part of the cornea of the right eye. Superficial corneal ulcer was diagnosed in left eye and BK in right eye, both probably in consequence of ectopic cilia presence. Surgical intervention was made, with the cauterization and excision of the ectopic cilia and third eyelid flap in the right eye. The cauterization of caruncle trichiasis was not authorized by the owner. Moxifloxacin eye drops in the dose of one drop four times a day in both eyes, lubricant based on hyaluronic acid in the dose of one drop four times a day in both eyes, and autogenous blood serum, obtained from the centrifugation of a blood sample of the dog itself, in the dose of one drop every hour in the right eye for 24 hours, and meloxicam in the dose of 0.1 mg/kg every 24 h for 3 days were prescribed. Elizabethan collar was recommended until removal of the third eye flap. During the surgery, a sample of eye secretion was collected and sent for culture and antibiogram and did not show growth of microorganisms. After seven days of the procedure, the animal did not show eye discomfort and corneal ulcer in the left eye was healed. The third eye flap remained stable until the return of 28 days and after removal of the capton, adhesions were identified, which were removed with Castroviejo scissors after application of topical anesthetic proxymetacaine hydrochloride eye drops. A fluorescein test was performed and the absence of corneal keratitis was confirmed. Discrete corneal scars (macula) were identified.Discussion: The patient in this report had several changes in ocular morphology that favored the formation of recurrent injuries which contributed to the formation of BK. The use of topical medications as unique treatment was not performed due to the severity of the lesion and the presence of alterations such as medial entropion, caruncle trichiasis and ectopic cilia that needed surgical corrections to resolve the causes of the lesions. In order to protect the cornea and provide compression of its epithelium, a third eyelid flap was performed, a low-invasive procedure that is quick and easy to perform. Ectopic cilia were cauterized to eliminate one of the causes of the corneal injuries, however, the other changes could not be corrected because they were not authorized by the owner. The adjuvant uses of ocular lubricant based on hyaluronic acid, a broad-spectrum topical antibiotic and mainly autogenous blood serum favored the epithelial reconstruction of the cornea by providing protection, vitamins, growth factors, immunoglobulins, anti-collagenolytic and bacteriostatic substances. The protocol used it enabled a rapid reduction in patient discomfort, reversal of injuries and recovery of visual function.

Epibulbar complex choristoma with simultaneous involvement of eyelid: a case report

Background Epibulbar complex choristoma, a rare congenital epibulbar tumor, has many diverse forms. Reviewing the literature, it can present clinically as either a circumferential or isolated epibulbar mass, limbal tumor, lateral canthal mass, aggregate of ectopic cilia in the upper eyelid, eyelid mass mimicking chalazion, or lacrimal caruncle mass. The management depends on the extent of involvement, the risk of amblyopia, and cosmetic concerns. Here, we report an atypical presentation of epibulbar complex choristoma with simultaneous eyelid involvement. Case presentation A 1-month-old full-term boy was brought to our clinic with congenital epibulbar mass of the right eye with simultaneous eyelid involvement. Dilated fundus examination was unremarkable. Survey for linear nevus sebaceous Jadassohn was negative. Due to concerns of possible amblyopia and cosmetics, lamellar keratectomy, sclerotomy, and conjunctivoplasty were performed to remove the epibulbar lesion. The eyelid defect was reconstructed with 6–0 Vicryl sutures. Histopathological examination reported complex choristoma. Upon three-year follow-up, low astigmatism and favorable cosmetics results were achieved. Conclusions Congenital complex choristoma can present clinically as an epibulbar mass with eyelid involvement. The management depends on the extent of involvement, the risk of amblyopia, and cosmetic concerns. The method of eyelid reconstruction should be tailored according to the residual eyelid defect.

Ectopic Eyelid Cilia in a 15 years old Girl: A Rare Presentation

Introduction: Eyelashes are unique hair follicles normally found at the eyelid margin. The spectrum of cilial anomalies includes cilial row duplication, agenesis and ectopic placement. Ectopic cilia are the rarest of cilial anomalies. Case Report: A 15 years old girl presented with the complaints of eyeache and headache for three months. She also complained of extra lashes over left upper eyelid with secretion of tears while crying from the area of extra lashes. She was a diagnosed case of epilepsy under treatment for three months. On examination, visual acuity was 6/6p in right eye and 6/6p in left eyewith best corrected visual acuity being 6/6 with -0.25DS in both the eyes. The anterior and posterior segment findings were normal except for presence of extra bunch of cilia on the temporal side of the left upper eyelid two mm above the upperlid crease with dimpling of the underlying skin. Conclusion: Ectopic cilia,a rare congenital condition, is asymptomatic and surgical treatment can be done for cosmetic correction. Keywords: cilia, ectopic, eyelid