Getting hooked: Eyelash in lacrimal punctum.

A 23-year-old female presented with redness, discharge and irritation in right eye for past 4 days with constant watering. She was diagnosed with nodular episcleritis elsewhere. Her best corrected visual acuity was 6/6 in both eyes. Slit lamp evaluation revealed sectoral congestion localized to right nasal bulbar conjunctiva with fluorescein uptake in an area of 4 ∗ 1.8 mm temporal to plica semilunaris (Fig 1A). Everted eyelid showed an eyelash dislodged into upper lacrimal punctum with its root protruding onto the surface (Fig 1B). Area of conjunctival epithelial defect corresponded to the area of lash-surface touch in a closed eyelid (Fig 1C). Eyelash was removed with the help of atraumatic forceps (Fig 1D). Irrigation via lower punctum was patent.

Fig. 1

A, Slit lamp image showing right nasal bulbar conjunctival congestion with a localized elevated nodule medially. B, Root of lash follicle impacted into upper lacrimal punctum. C, Slit lamp image (16×) under cobalt blue filter showing an area of fluorescein uptake (borders marked) corresponding to lash-surface contact in closed eyelid. D, Removed lash follicle (held in forceps) with thin mucoid strand over its surface.

Comment

Eyelash arrest in lacrimal punctum is a very rarely seen phenomenon. Unrecognised retained intraocular foreign bodies in young children can present as unilateral conjunctivitis/keratoconjunctivitis. Eyelash impaction in lacrimal punctum has been reported only once in literature where conjunctival granuloma was excised along with lash removal. In our case, eyelash removal alone resolved the symptoms promptly. Careful ocular evaluation with everted eyelid inspection should be performed to rule out hidden foreign bodies.

Conflict of interest

The authors declared that there is no conflict of interest.