Turgut et al., Int J Ophthalmic Pathol 2013, 2:3 http://dx.doi.org/10.4172/2324-8599.1000117
International Journal of Ophthalmic Pathology
Case Report
a SciTechnol journal
Recurrent Pterygium with Cilia Mimicking Ectopic Cilia Burak Turgut1*, Sermal Arslan2, Fatih Cem Gul3 and Onur Çatak2
Abstract We report a very rare case with recurrent pterygium with cilia mimicking ectopic cilia. The history of the patient revealed prior pterygium excision operations. A slit-lamb examination revealed the recurrent pterygium with cilia in the nasal region. In the nasal region, the caruncular tissue which normally has cilia dragged by the residual base of the pterygium may be speculated to ectopic cilia. Keywords Recurrent pterygium; Cilia; Caruncle; Caruncular dragging
Introduction Pterygium is a benign lesion which characteristically occurs at the nasal or temporal limbus due to the elastoid degeneration of the conjunctiva. The main risk factors are dryness, hot weather and ultraviolet rays. The key feature of pterygium pathogenesis is focal limbal failure. The caruncle is a soft, pink, ovoid body which has about 5mm high and 3mm broad, situated in the lacus lacrimalis medial to the plica semilunaris. Caruncule may include skin elements, such as hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue [1]. The epithelium is non-keratinized, stratified squamous similar to the conjunctival epithelium, and the sebaceous glands are like those of the lids and the hairs [2]. Recurrent lesions are more difficult to be controlled than primary pterygia. Recurrent pterygium has recurrence rates of 25–45% after surgery [3-5]. We report that recurrent pterygium with cilia could be confused with ectopic cilia.
Case Report
She has worked on field as she is a farmer and she had not wore sunglasess. There was no family history of any similar disorder. She has not used any postoperative antiinflammatory medication. Visual acuity was 20/20 in both eyes. In slit lamp examination, the left eye had a vascularized fibrotic lesion that had invaded corneal midcentral area with numerous cilias (Figure 1). Caruncular tissue which normally has cilia had been dragged through the cornea. We found only minor astigmatisma without decrease visual acuity on refraction examination. Biomicroscopic examination did not reveal any sign to be attributed any corneal surface disease. The right eye had a normal appearance. The patient refused the excision of recurrent pterygium. Symptomatic treatment including artificial eye drops and nonsteroidal antiinflammatory drops was started.
Discussion A number of treatment modalities including surgical excision with bare scleral excision, primary closure, use of autologous conjunctival and limbal grafts, conjunctival rotation flaps, application of β-irradiation, administration of mitomycin C and amniotic membrane transplantation have been described in the treatment of pterygium. The use of topical mitomycin C and β-irradiation have significantly reduced recurrence rates [5,6]. Despite numerous surgical approaches and developments, the management of recurrent pterygium is still a difficult problem for many ophthalmologists. Extensive surgical excision for recurrent or large lesions can lead to further limbal stem cell deficiency and cicatricial changes in the ocular surface [3,4]. Bare scleral closure as a technique generally implies the removal of the pterygium with excision of some of the bulbar conjunctiva nasally, leaving the defect to heal from the surrounding conjunctiva. This technique has high recurrent rate, which may range as high as 80%. Conjunctival autograft includes transplantation of a free conjunctival tissue from another part of the ocular surface, usually from the supero-temporal limbus following the removal of the pterygium. Recurrence rates have been reported as low as 2% and as high as 40%. This method of removal appears to reconstruct a more normal limbal anatomy with a better cosmetic result with respect to vascularization and probably a more acceptable recurrence rate than the other procedures [7].
A 58-year-old woman admitted to our university hospital with the complaints of foreign body sensation, sting, redness and pain in her left eye for fifteen months. Her history revealed prior two pterygium excision procedures. Two surgery type was same. Simple bare scleral excision had carried out to patient without application of antimetabolite or β- irradiation and amniotic membrane transplantation. One year ago, she had undergone bare scleral excision of nasal pterygium. In the second surgery, three months earlier, a nasal recurrent pterygium had been excised without any conjunctival graft or rotation flap. *Corresponding author: Burak Turgut, Associate Professor of Ophthalmology, Fırat University School of Medicine, Department of Ophthalmology, Elazig Turkey, Tel: +904242333555; Fax: +904242388096; E-mail:
[email protected] Received: December 21, 2012 Accepted: February 05, 2013 Published: February 13, 2013
International Publisher of Science, Technology and Medicine
Figure 1: A color photograph shows pterygium invading on mid central cornea and displacement of caruncular tissue overlying numerous cilia in the left eye.
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Citation: Turgut B, Arslan S, Gul FC, Çatak O (2013) Recurrent Pterygium with Cilia Mimicking Ectopic Cilia. Int J Ophthalmic Pathol 2:3.
doi:http://dx.doi.org/10.4172/2324-8599.1000117 Ectopic cilia is a rare condition arising from disturbance of the position of the eyelashes. The pathogenesis of the ectopic cilia is contraversial. It has been hypothesized that ectopic cilia might result from substitution of ectopic lashes originate from lash follicles by Meibomian glands. However, some authors reported that histological examination of these lesions revealed that they have normal Meibomian glands. Ectopic cilia must be differentiated from abnormally placed hairs. Histological evaluation of these lesion may provide considerable information for this differentiation. The caruncle histologically consists in addition to conjunctiva, hair follicles, sebaceous, sweat and accessory lacrimal glands and goblet cells. Caruncular epithelium is non-keratinized, stratified squamous similar to the conjunctival epithelium. Accessory lacrimal glands are often located on the centre of the caruncle [8-12]. Excessive resection of a recurrent or large pterygium especially including the plica semilunaris might cause dragging of caruncle that normally includes cilia. Additionally, as seen in our current case, multipl surgery or bare scleral excision without any conjunctival graft or rotation flap may be considered a risk factor for the development of caruncular dragging. Ptergium excision with use of conjunctival graft or rotation flap and amniotic membrane transplantation might prevent this surgical complication. In conclusion, as the case is presented, dragging of the caruncular tissue which normally has cilia by the residual base of the pterygium over the cornea may speculate to ectopic cilia [13]. To our knowledge and pubmed the search, there is no case that recurrent pterygium with cilia was reported. Acknowledgments The authors indicate no financial support or financial conflict of propriary
interest. Involved in conduct of study (B.T., S.A., F.C.G., O.Ç.); collection of data, typing and editing of manuscript and preparation, review, or approval of the manuscript (B.T., S.A., F.C.G., O.Ç.). This paper has been presented as Poster in 44th National Congress of Turkish Ophthalmology Society, Antalya/TURKEY.
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Author Affiliations
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Fırat University School of Medicine, Department of Ophthalmology, Elazig, Turkey 2 Elazig Research and Training Hospital, Ophthalmology Clinic, Elazig, Turkey 3 Harput State Hospital, Ophthalmology Clinic, Elazig, Turkey 1
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