|Year : 1966 | Volume
| Issue : 6 | Page : 253-257
HS Agarwala, WK Munshi
Dept. of Ophthal. R. G. Kar Medical College & Hospitals, Calcutta, India
|Date of Web Publication||17-Jan-2008|
H S Agarwala
Dept. of Ophthal. R. G. Kar Medical College & Hospitals, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwala H S, Munshi W K. Aberrant eyelashes. Indian J Ophthalmol 1966;14:253-7
Eyelashes are normally stiff and darker than hair. They grow forward in two or three irregular rows from the anterior rounded border of the lid. As quoted by Duke-Elder, Cherno (1907) remarked that they may be regarded as deciduous hairs. The lashes of upper eyelid are longer than those of the lower. People with darker hair and skin generally have longer eyelashes by 1 m.m. or so than those of blondes. (Majewski 1958). The average life of a lash is 3 to 5 months. The cilia at an early stage have knob-like ends, but the matured stage present club-shaped tops.
Various anomalies, that are encountered with respect to its directions are shown in [Figure - 1].
1. Trichiasis. 2. Distichiasis. 3. Cilium Inversum. 4. Cilium Incarnatum Internum. 5. Cilium Incarnatum Externum.
| 1. Trichiasis|| |
It is an acquired condition, where eyelashes, although they grow normally, are turned inward and are usually associated with some pathological inturned condition of the lid. This is commonly met with in trachoma and blepharitis, in the case of upper lid, and with senile spasm of orbicularis oculi muscle in that of the lower lid. Occasionally symblepharon may produce a similar effect.
Duke-Elder (1952) prefers to use the term inversion or retroflexion of the lashes, in connection with inferior epiblepharon, a developmental anomaly, where the inferior rectus muscle may have some anomalous insertion into the skin of the lower lid, or defective asymmetric development of fascial planes in relation to the orbit.
As there exists a condition called cilium inversum, a different entity, we think, retroflexion of lashes is a more suitable term to distinguish such an aphysiological position from trichiasis which is a cicatrical condition. The same term retroflexion should also be used in connection with senile spastic entropion.
H.S.A. came across three cases of such peculiar aphysiological perforation of cilia in adult females. Though all eyelashes appeared normal, yet the lower lid margins presented a few inward turned cilia causing annoyance by rubbing against the globe. The lids and conjunctivae were perfectly normal and healthy. Relief was achieved by epilation. Two cases did not come back, but one returned with the same complaint of irritation and presented a regrowth of retroverted cilia, within two months. Catholysis gave a permanent relief to her. Recently, three more cases of the same type were seen in a month. They were adult women of 38, 50 and 55 years of age, and all of them presented the anomaly in their lower lids, which were otherwise healthy.
| 2. Distichiasis|| |
This is a congenital condition, where eyelashes are found in two different vertical planes, growing in two opposite directions. One row is in normal place and the other abnormal row consists of lashes emerging through the openings of the Meibomian glands and are directed posteriorly. Here Meibomian glands (modified sebaceous glands) are very rudimentary and sometimes only acini are present.
H.S.A. observed a peculiar modification in two different cases about a year ago in a Bengali woman of 28 years and in a Bengali man of 35 years. Each of them complained for the last 10-1.2 days of pricking sensation in the affected eye while moving the globe. On examination, the eyes and the lids were found perfectly normal, except that the woman presented one single eyelash in her right eye and the man presented a similar condition in his left eye, emerging from the opening of one single Meibomian gland, at the junction of the outer and the middle third of the lower lid margin. This anomalous eyelash was of normal colour and texture. While epilating, they came out very easily, offering no resistance at all. The portion inside the tarsal gland was about 3 m.m. Apparently it seemed a case of a foreign body (an eye lash) in a Meibomian gland.
Literature does not reveal any such condition. On one occasion, we did observe an eyelash in the lower punctum, which is an opening situated more or less in the same alinement of Meibomian glands. Stern (1952) gave a probable explanation of suction due to negative pressure in the lacrimal sac. But tarsal gland being holocrine gland, is packed with cells all through. Hence entry of the lash through its duct is not possible. However, while attempting reinsertion, the eyelashes could easily be got in, in both the cases. Again, the term distichiasis could not be appropriate for it, as there was no binding at the root of the eyelash. It is likely that it could be a cut or a dropped eyelash implanted into the punctum itself, getting into it along with the flow of tears, or that an eyelash grew inside the gland which subsequently emerged out from a break-down of the gland.
Simple epilation relieved the cases and they did not come again.
| 3. Cilium Inversum|| |
It is a very rare condition, where an eyelash instead of emerging forward, emerges through the posterior border of the lid margin.
Tibbles (1923) first reported of its occurrence in a woman of 21 years, who after having the trouble of irritation for three weeks presented two such in-growing eyelashes. One was at the posterior border of the lid margin and the other one appearing in the subtarsal sulcus. Duke-Elder (1952) mentions Schrieber (1924) as the next one to report it. No mention of such cases are found in literature after that.
In July 1959, H.S.A. found its occurrence in a Bengali male of 29 years. A 3 m.m. tiny eyelash was just presenting as a black pin-point in the posterior border of the upper lid margin of the right eye. Whenever he blinked, he felt severe smarting scratching sensation in his eye. Closure of the eye only could give relief. As a result of rubbing of the pointed end of the lash against the eyeball, peripheral and mild circum-corneal congestion with a few corneal abrasions were present. Permanent relief was achieved after epilation followed by cauterisation of follicles. The patient is perfectly well since then. This case was published in 1963.
About a year and a half ago, H.S.A. had another case. The patient was a Nepali male of 30 years. He had acute symptoms of a pricking sensation and irritation in his left eye for the last two and half months. On examination, he presented moderately swollen upper left lid with engorged blood vessels under the skin. The upper cornea presented superficial haze with congestion of superficial conjunctival blood vessels all over. There was profuse watering. There was a long history of using drugs of all kinds. Along the posterior border of upper lid margin, two black pointed ends of eyelashes were found, which came out very easily on epilation. Patient is perfectly well since then.
It is curious to note that all patients having such lanugo type of hair presented aberration during their third decade of life. The symptom of pricking is very agonising and acute in such cases. This is due to the direct contact of the posterior border of the upper lid margin with the cornea. Such abnormal eyelashes are found growing in the middle third of the upper eyelid laterally. Mistake in diagnosis is quite likely to occur, unless one pays careful attention to the stated part, where the cilium lies almost concealed, with the pointed pricking end just peeping through.
| 4. Cilium Incarnatum Internum|| |
It is another illustration of a very rare occurence of ectopic cilia, where eyelashes grow underneath the conjunctiva and subsequently emerge in the space between the palpebral and the bulbar parts of the conjuctivae.
Bloch (1947) and Casnovas (1955) agree that such perverted growth of eyelash takes place because of its encountering an obstruction in the process of growth and so it takes its course of least resistance. We think, they arise from misplaced hair follicles.
Case 1. A muslim male of 27 years came with the complaint of foreign body sensation in his right eye for three days.
On examination, no congestion of blood vessels was to be seen and the eye had a perfectly normal look. On eversion of the upper lid, at the centre of the tarsal conjunctiva, a hair was found, which was straight and half buried in it. Epilation completely cured his condition.
Case 2. A Hindu female of 30 years came with similar complaint of pricking sensation in her right eye for two days.
On examination, she was found distressed. Her eye was watering profusely. Upper peripheral congestion was there. On eversion of the upper lid, an eyelash was found sprouting from the junction of the middle and the inner third of the marginal part of conjunctiva directed towards the subtarsal sulcus. Simple epilation relieved her completely.
Case 3. A Hindu male of 27 years came with the same complaint of foreign body sensation in the left eye for the last two days.
On examination, his eye was found watering. Upper tarsal conjunctiva presented centrally a bunch of wavy eyelashes underneath it. Those were superficial and were just shooting upwards. Those were about 3 mm. in length and having wavy undulations about 1 mm. apart. They were brittle and less black. Microphotograph showed one hair with split ends [Figure - 2]. Bulbar conjunctuctiva opposite to those lashes presented slight engorgement of vessels.
Simple epilation relieved him.
Like cilium inversum, all above referred cases are found in their third decade of age. The affected site is the middle third of the upper lid. The cases so far reported, presented straight hair. Wavy hair in the third case, might be due to its passage over Meibomian glands. Moreover, its brittleness and splitting tendency supports Fragilitis Crinium, which is found again in association with follicular atrophy (Duke-Elder 1952). Further, under higher magnification, microphotograph showed the nature of the curly hair to be lanugo type [Figure - 3]. The more those lashes appear near the margin of the lid, as depicted in the second case, the clinical picture becomes more acute and severe.
N.K.M. referred its occurrence in a man aged 50 years, where a single cilium was observed along with a granuloma at the central region of the tarsal conjunctiva of the right upper lid. After epilation it grew there again along with a granuloma, in three months. After removal by catholysis, he was finally cured.
Duke-Elder (1952) mentions epilation corrects the aberration, but recurrence may have to be similarly dealt with. Obviously, the above case confirms that catholysis is surely a better treatment in a case of recurrence. Recurrent growth of granuloma and hair is an additional feature to note.
| 5. Cilium Incarnatum Externum|| |
Duke-Elder (1952) mentions this as an occasional hereditary condition, where an eyelash after coming out obliquely from the follicle, pierces again the epitheleum of the skin and grows underneath it. Sometime, it grows beneath the epidermis throughout the whole of its course. It is homologus to pili incarnati, found in the region of beard and leg.
| Summary|| |
Various anomalies met with in eyelashes are discussed along with an introductory note on normal cilia.
Under each stated aberration, clinical peculiaries are illustrated with case reports.
| References|| |
Agarwala, H.S. (1963) : Am. J. Ophthal., 55: 648-649.
Bloch, (1947): Arch. of Ophthal. 37: 772.
Casnovas, J. (1955) Am. J. Ophthal. 40: 608.
Duke-Elder, W. S. (1961): System of Ophthalmologv. Vol. 2. Henry Kimpton, London. 1961, p. 524.
Duke-Elder. W. S. (1952): Textbook of Ophthalmology. Vol. 5. Henry Kimpton, London, 1952. pp. 4660, 5016, 5017, 5019.
Majewski, K. W. (1959): Am. J. Ophthal. 47: 740.
Stern, J J. (1952) : Am. J. Ophthal. 35: 1206.
Tibbles. S. (1923): Brit. Med. J., 2: 521.
Wolf E. (1948): The Anatomy of the Eye and Orbit. 3rd Ed. H. K. Lewis & Co. Ltd., London, 1948, p. 143.
[Figure - 1], [Figure - 2], [Figure - 3]