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Year : 2022  |  Volume : 60  |  Issue : 2  |  Page : 212-213

Hair Shaft in the Lacrimal Punctum: A Rare Presentation


1 Department of Cornea and Refractive Surgery, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
2 Department of General Ophthalmology, Sankara Eye Hospital, Guntur, Andhra Pradesh, India

Date of Submission04-Aug-2020
Date of Acceptance21-Sep-2020
Date of Web Publication30-Jun-2022

Correspondence Address:
V Nishant Janardhana Raju
Sankara Eye Hospital, Vijayawada-Guntur Expressway, Pedakakani, Guntur - 522 509, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_103_20

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  Abstract 


We report a rare case of 18-year-old male presenting with redness, watering and pain in right eye for past 2 days. He was diagnosed as bacterial conjunctivitis elsewhere and started on gentamycin (0.3%) eye drops four times a day to which symptoms are not relieved. Slit lamp examination of right eye revealed sectoral congestion confined to nasal bulbar conjunctiva temporal to plica semilunaris, which was initially confused with inflamed pinguecula and episcleritis. Careful examination of ocular adnexa led to revelation of hair shaft in the upper lacrimal punctum and timely removal of the hair shaft helped us in alleviation of patients morbidity.

Keywords: Episcleritis, hair shaft, inflamed pinguecula, inflamed pterygia, lacrimal punctum


How to cite this article:
Raju V N, Potti S, Anne H. Hair Shaft in the Lacrimal Punctum: A Rare Presentation. TNOA J Ophthalmic Sci Res 2022;60:212-3

How to cite this URL:
Raju V N, Potti S, Anne H. Hair Shaft in the Lacrimal Punctum: A Rare Presentation. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Dec 1];60:212-3. Available from: https://www.tnoajosr.com/text.asp?2022/60/2/212/349503




  Introduction Top


Sectoral congestion of the eye encompasses wide range of factors. We report a rare scenario wherein piece of scalp hair shaft stuck in upper lacrimal punctum rubbing over the adjacent bulbar conjunctiva causing sectoral congestion, pain and watering.


  Case Report Top


A 18-year-old male presented with symptoms of redness, watering and pain in the right eye for last 2 days. He is negative for comorbidities and had no history of trauma. He was diagnosed to have bacterial conjunctivitis elsewhere and started on gentamycin (0.3%) eye drops four times a day.

At presentation his unaided vision was 6/6, N6 in both eyes. Intraocular pressure was digitally normal. On slit lamp examination, right eye revealed sectoral congestion confined to nasal bulbar conjunctiva temporal to plica semilunaris [Figure 1], cornea was clear and anterior chamber was quite.

Initially it was interpreted to be episcleritis, but on careful examination eyelash tip (assumed) was seen projecting from upper lacrimal punctum [Figure 2]. On fluorescein staining conjunctival epithelial defect of 3 mm height and 5 mm width was noted [Figure 3]. The area of conjunctival epithelial defect corresponded to the area of exposed eyelash in a closed eyelid. There was no associated inflammation of the draining canaliculus or any eyelid disease likely to cause trichiasis.
Figure 1: Slit photograph of right eye showing sectoral congestion confined to nasal bulbar conjunctiva

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Figure 2: Slit lamp photograph of right eye showing hair shaft in upper punctum

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Figure 3: Slit lamp photograph of right eye showing conjunctival epithelial defect taking fluorescein stain

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Initially thought to be a ectopic eye lash, planned for removal with epilation forceps. Eye lash was removed without any resistance proving that it was just lying not growing from punctum [Figure 4]. Moreover morphology of it was more like scalp hair shaft rather than eye lash since it was straight unlike eyelash.[1] On further probing, patient told symptoms are aggravated while closing eyelid and also gave history of haircut following which he developed above symptoms. During haircut, cut piece of scalp hair shaft has gained access to conjunctival cul de sac and reached punctum causing above symptoms. Patients was symptomatically relieved soon after removal of hair shaft and was given chloramphenicol and dexamethasone combination eye drops four times a day for week to counter the inflammation. After 1 week redness resolved and patient had no pain and watering.
Figure 4: Photograph showing epilation forceps with the recovered piece of hair shaft

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  Discussion Top


Any foreign body which gains access to the conjunctival cul de sac causes irritation and reflex lacrimation and drained out through the lacrimal drainage system. Likewise in our case the cut hair shaft reaching conjunctival cul de sac got carried away to the lacus lacrimalis which brings it in close proximity to the lacrimal punctum, from here it might have travelled into the punctum either due to propelling action of the eyelids or due to negative pressure created in the canaliculus in each blink cycle.[2] Eyelashes are reported to enter the upper punctum more frequently than the lower punctum.[3] Once the hair shaft enters into the punctum, the barbs on the hair prevent it from being expelled and causes abarasion of bulbar conjunctiva that it comes in contact with every blink leading to a vicious cycle causing redness, pain and watering.[4]


  Conclusion Top


The unusual complaint of symptoms aggravating on closing eyelid helped us in identifying root cause of symptomatology, thus signifying the importance of detailed history taking and careful examination of ocular adnexa in cases with localized congestion with pain and should not be mistaken for an inflamed pinguecula or episcleritis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Snell RS, Lemp MA. Clinical Anatomy of the Eye. Boston: Blackwell Scientififc Publications; 1989.  Back to cited text no. 1
    
2.
Gutteridge IF. Curious cilia cases. Clin Exp Optom 2002;85:306-8.  Back to cited text no. 2
    
3.
Nagashima K, Kido R. Relative roles of upper and lower lacrimal canaliculi in normal tear drainage. Jpn J Ophthalmol 1984;28:259-62.  Back to cited text no. 3
    
4.
Taneja S, Arora R, Yadava U. Fingernail trauma causing corneal laceration and intraocular cilia. Arch Ophthalmol 1998;116:530-1.  Back to cited text no. 4
    


    Figures

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



 

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