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Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 148-150

Two cases of posterior ectopic cilia: A brief report

Department of Ophthalmology, Rajiv Gandhi Medical College, Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India

Date of Submission26-Jul-2013
Date of Acceptance19-May-2014
Date of Web Publication16-Aug-2014

Correspondence Address:
Dr. Rakesh K Barot
12, Jyotinagar CHS, Four Banglows, Near RTO, Andheri West, Mumbai - 400 053, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2320-3897.138859

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Ectopic cilia is a very rare congenital anomaly. The authors present two cases of posterior ectopic cilia and review the literature. In both cases, the ectopic cilia presented as dark lesions under tarsal conjunctiva. The cilia were present in two tufts in curved manner, adherent to each other without protruding from the conjunctiva and embedded deeply in the posterior tarsal plate. This presentation is considerably different from previously reported cases of posterior variety and represents a distinct clinical entity of ectopic cilia.

Keywords: Conjunctiva, ectopic cilia, tarsal plate

How to cite this article:
Barot RK, Momin AR, Baile RB, Pattiwar MS, Manglani NH. Two cases of posterior ectopic cilia: A brief report. J Clin Ophthalmol Res 2014;2:148-50

How to cite this URL:
Barot RK, Momin AR, Baile RB, Pattiwar MS, Manglani NH. Two cases of posterior ectopic cilia: A brief report. J Clin Ophthalmol Res [serial online] 2014 [cited 2022 Dec 3];2:148-50. Available from: https://www.jcor.in/text.asp?2014/2/3/148/138859

Cilia or eyelashes are normally found at the lid margin but may form rare anomalies including cilial row duplication, agenesis, and ectopic placement. [1] Ectopic cilia, a congenital anomalous position of eyelashes, is a rarely reported condition in humans as it is usually asymptomatic. The authors report two cases of posterior ectopic cilia with unusual presentation and review the literature. This presentation is far different from previously reported cases of posterior variety.

  Case Reports Top

Case 1

A 27-year-old male presented with foreign body sensation in right eye since 30 days and gave history of noticing dark elevated area on eversion of right upper lid. He had no ocular injury or operation in the past. Slit lamp examination revealed a dark elevated serpiginous area (6 mm × 2 mm) in the middle of tarsal subconjunctival space of the right eye [Figure 1]. The overlying conjunctiva was intact. Rest of the ocular examination was normal. At operation, a chalazion clamp was applied and a vertical incision was made on conjunctiva at the margin of the lesion. Two tufts of cilia were seen embedded deep in the tarsal plate. These cilia were adherent to each other and were removed with fine forceps [Figure 2]a. Each tuft had approximately 20 black cilia (6-7mm each; [Figure 2]b. There was no recurrence and the patient was asymptomatic till last follow up at 18 months [Figure 3].
Figure 1: Serpiginous dark elevated lesion in subconjunctival space (case-1)

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Figure 2: (a) Surgical removal of ectopic cilia (b): Excised tuft of cilia

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Figure 3: Post-operative follow-up of case-1 at 6 months

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Case 2

After everting the left upper eyelid of an 11-year-old male child presenting with blepharitis, two dark-colored lesions (3 mm × 1 mm) were seen in the middle of tarsal subconjunctival space [Figure 4]. Clinically, a diagnosis of posterior ectopic cilia was made based on the experience of case-1 which presented 3 months back. It was left alone as the ectopic cilia were asymptomatic.
Figure 4: Two tufts of ectopic cilia in subconjunctival space (case-2)

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  Discussion Top

Ectopic cilia are defined by their positions with respect to the tarsal plate, anterior and posterior. [2] The ectopic cilia originating anterior to tarsal plate are found consistently in the lateral quarter of the upper eyelid suggesting embryological origin. [2] The exact etiology of posterior variety is not known. The posterior lesions present as single or multiple cilia beneath the conjunctiva with varied positioning.

A review of literature has revealed only 22 cases of ectopic cilia reported previously, probably because many cases remain either undetected or unreported. Of these only 7 cases, aged 5-46 years were of posterior variety and the rest were anterior.

Weigman reported the first case in 1936 wherein an ectopic cilium grew from the middle of the conjunctival surface of the tarsus, in which it was deeply embedded. [3] Tavolara reported two ectopic cilia from tarsus grown into the conjunctival sac in association with distichiasis and histological observations seemed to indicate the possibility of a substitution of some meibomian glands by the abnormally implanted lashes. [4] Bader reported dark spots under the tarsal conjunctiva formed by the replacement of meibomian glands by lash follicles. [5] Jain and Saini accidently noticed an eyelash buried deeply on the conjunctival surface of the tarsal plate in both eyes of a child while examining for vernal conjunctivitis. [6] Guler et al., reported several black-white ectopic cilia with follicles protruding from the conjunctiva causing conjunctival hyperaemia and intermittent pain in the eye. [7] Hase et al., reported two cases, the first case with three cilia in the upper palpebral conjunctiva and mild superficial punctuate keratopathy, and a second case with a single cilium in the upper palpebral conjunctiva and hyperemia of the eye. [8] Histopathological analysis of excised cilia in both cases did not show dermal papillae and hair matrixes, which are known to produce hair follicles, indicating that the cilia did not arise from the conjunctiva in situ. The cilia were associated with the anatomical features of crypts of Henle and chronic inflammation suggesting the etiology as acquired aberrant.

Of interest, ectopic cilia are not unique to humans. Similar cases in veterinary literature emphasize the close association between ectopic conjunctival cilia and the underlying meibomian glands. [9]

In our cases, the ectopic cilia were deeply embedded in the posterior part of tarsal plate. Case-1 was symptomatic as the lesion probably had enlarged and got elevated over time while case-2 was asymptomatic since the lesion was smaller and flatter.

In case-1, the lesion was unusual, not fitting into any known clinical anomaly of lid and the patient was symptomatic. Therefore, operation was decided. At operation, the adjoining conjunctiva and tarsal plate were found to be normal and the cilia were arranged in regular manner ruling out foreign body granuloma. Regular arrangement of cilia is also improbable in cases of post-trauma implantation of cilia. Therefore, the diagnosis of ectopic cilia was made.

To the best of our knowledge, the reported cases are the first ones in which the ectopic cilia were present in two tufts in curved manner, adherent to each other without protruding from the conjunctiva and embedded deeply in the posterior tarsal plate. This presentation is considerably different from previously reported cases of posterior variety where either a single lash or multiple non grouped protruding cilia were found beneath the conjunctiva. Therefore, it represents a distinct clinical entity of ectopic cilia.

Our cases illustrate that ectopic cilia of posterior variety may remain asymptomatic for a long time. Ectopic cilia may be considered as a differential diagnosis when a dark lesion is noted on the tarsal conjunctival surface.

  References Top

1.In: Duke-Elder S, editor. System of ophthalmology. 3 rd Vol. Normal and abnormal development. Pt. 2: Congenital deformities. St. Louis: CV Mosby; 1964. p. 872-81.  Back to cited text no. 1
2.MacQuillan A, Hamilton S, Grobbelaar A. Angiosomes, clefts and eyelashes. Plast Reconstr Surg 2004;113:1400-3.  Back to cited text no. 2
3.Wiegmann E, Mittelungen, Fragenaus der Praxis. Eine Zilieaneinemungewo¨hnlichenPlatz, imKnorpel des Oberlides. Klin Monatsbl Augenheilkd 1936;96:230-1.  Back to cited text no. 3
4.Tavolara L. On a case of lashes arising in anomalous site in a patient with congenital distichiasis. Boll Ocul 1959;38:194-201.  Back to cited text no. 4
5.Bader A. Congenital aplasia of the meibomiam glands of the lower eyelid. Albrecht Von Graefes Arch Ophthalmol 1950;150:411-3.  Back to cited text no. 5
6.Jain SC, Saini VK. Bilateral ectopic cilia (a case report). Indian J Ophthalmol 1985;33:67-8.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Guler M, Yilmaz T, Guler O. A case of ectopic cilia. Int Ophthalmol 2009;29:297-8.  Back to cited text no. 7
8.Hase K, Kase S, Noda M, Ohashi T, Shinkuma S, Ishida S. Ectopic cilia: A Histopapathological study. Case Rep Dermatol 2012;4:37-40.   Back to cited text no. 8
9.Helper LC, Magrane WG. Ectopic cilia of the canine eyelid. J Small Anim Pract 1970;11:185-9.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
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Yahya Al-Najmi, Maram AbdallaElsayed
Case Reports in Ophthalmology. 2020; 11(3): 626
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