Mystery eyelid lesion!
This subcutaneous eyelid elevation was caused by a misdirected eyelash – also know as “cilium incarnatum externum.” This particular patient was referred in by her dermatologist to rule out a possible cancer on the eyelid. It was a big relief for the patient to learn that the culprit was an eyelash. Removal was a breeze!
Interestingly, patients with dry eye from blepharitis and ocular rosacea often have misdirected eyelashes. So, cilium incarnatum externum can be associated with dry eye.
Eyelid lesions can range from benign growths to malignancy. It is always important to have these lesions examined, and if there is any doubt, have it biopsied and sent to pathology especially If you have had sun exposure or a history of skin cancers. Patients are often surprised to learn that skin cancers (like basal cell carcinoma, melanoma, and squamous cell carcinoma) can occur on the eyelid margin just like on the skin.
Finally, these same cancers can occur on the eyeball it self— such as on the conjunctiva or even on the cornea. Dr. Fishman is researching a new technique for diagnosing these cancers without the need for physical biopsy- he is using micro-sized sterile tape to contact the lesion, capture the mRNA, then analyze the genetics for cancer.
Please check out Dr. Fishman’s ARVO paper paper: Tape Stripping: A Novel Noninvasive Method Using RNA Sequences for Diagnosing Ocular Surface Diseases of the Eye and Eyelid. Invest. Ophthalmol. Vis. Sci. 2020;61(7):392. Authors: Harvey Fishman MD PHD, Jonathan Mansbridge, Vera Morhenn.