Ectopic cilia in a Caucasian girl with atopic eczema.

Sir, curved cilium grew from the middle of the conjunctival surface of the right tarsus, in which it was deeply embedded. Ectopic cilia (EC ) is a very rare condition, and only a few In the majority of documented cases with this congenital cases have been reported in the literature since the first abnormality, a cluster of cilia is found on the anterior surface description by Wiegmann in 1936 (1). We here present the of the eyelid (4–8). Reports on the degree of vertical separation case of a 12-year-old Caucasian girl with a history of atopic of the ectopic cilia from the eyelid margin are varying. As an eczema and EC. To our knowledge, EC in a patient with extreme, Mackintosh & Grayson (9) found 2 cases of EC atopic eczema has not yet been reported. originating from the iris without any convincing history of injury to the eye, possibly due to lashes arising from a dermoid CASE REPORT cyst or teratoma. According to the hypothesis of ‘‘Meibomian gland A 12-year-old Caucasian girl with atopic eczema according to the substitution’’ (10), the ectopic lashes originate from lash criteria of Hanifin & Rajka (2) was referred for evaluation of a follicles, which completely or partially replace Meibomian congenital pigmented mole, measuring 1.8×1.2 cm, and extending glands. Bader (11) described a case with apparently normal horizontally in the upper inner quadrant of her right breast. Further eyelashes, in which some Meibomian glands were replaced by dermatological examination disclosed a tuft of 10 dark, densely lash follicles, appearing as dark spots under the tarsal conjuncgrouped cilia on the outer side of the girl’s right upper eyelid, 8 mm above the lash line (Fig. 1). tiva. Tavolara (12) reported a case in which two lashes The aberrant cilia had been present at birth, and apart from the originating in the tarsus grew into the conjunctival sac. cosmetic aspect, caused no apparent inconvenience. There was no Histological observations indicated the possibility of a family history of any similar disorder. On palpation, the tuft appeared substitution of some Meibomian glands by the abnormally deeply rooted to the underlying tarsal plate, projecting freely through implanted lashes. an aperture of the skin of the upper eyelid. Eversion of the right In opposition to this hypothesis is the observation by eyelid demonstrated a completely unaffected palpebral and bulbar Dalgleish (4), Owen (5) and Gordon et al. (8), who detected conjunctiva. Macroscopically as well as microscopically, no difference a normal Meibomian gland system in the cases where EC in the morphology of cilia harvested from the tuft and the lash line were present. could be found. Further ophthalmologic examination as well as EC must be differentiated from abnormally placed hair. general examination, including X-ray screenings and broad laboratory Dalgleish (4) emphasized the importance of histological examtests, were unremarkable. Elective excisional biopsy of the EC was ination of the lesion, with eyelashes characterized by the refused. presence of sweat glands of the large apocrine type attached The atopic eczema presented itself in a mild form (SCORAD-index to the follicles. As in our case, where excision and histological (3) 13/103), where only adequate hydration of the skin with emollients examination were declined, most reports on this subject have and avoidance of irritants were necessary. The congenital mole was failed to give proof of the presence of apocrine sweat glands excised under local anaesthesia. Results of histopathologic examinaattached to the hair follicles, which would verify the identity tion confirmed the presence of a naevomelanocytic naevus. The patient’s subsequent postoperative course was uneventful. as cilia (1, 6, 7, 13, 14). Nevertheless, macroscopically as well as microscopically, no difference between cilia from the ectopic spot and the eyelid margin could be found in our patient. DISCUSSION In humans, the association of EC with a small number of abnormalities is documented. Distichiasis and EC is reported The first report of EC was published in 1936 by Wiegmann by Bader (11) and Tavolara (12). Gordon et al. (8) described (1). He described the case of a 5-year-old girl, in whom a a complex choristoma of the right eyelid, containing EC and functioning aberrant lacrimal gland tissue, intermittently producing tears. As to the localized association of EC and cutaneous features of atopic eczema in the periorbital region in our case (Fig. 1), including a poorly defined scaly rash, a vanishing of the lateral eyebrows (Hertoghe sign) and extra infraorbital skin folds (Dennie-Morgan sign), no underlying common causative disorder became evident. Obviously, the observed association has to be evaluated as coincidental. Treatment of EC consists of excision. Partial regrowth of cilia after excision at the original site is found (6), possibly due to an incomplete surgical procedure. Palpebral EC is a very rare abnormality in humans, with only 11 cases documented in the literature. To our knowledge, this is the first reported case of such a lesion associated with atopic eczema.