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McCulley and associates¹ describe an intriguing case of ectopic cilia with presumed lacrimal gland secretion through an anomalous lacrimal ductule misdirected to the external eyelid. There is, however, another possibility that should be entertained in the differential diagnosis. Ectopic cilia may contain functioning lacrimal gland as a complex choristoma that is not discernable without histopathologic examination. When we first described this entity in 1991,² we thought that it was a rare anomaly, but we have since seen other cases presented by colleagues. Presumably, the ectopic lacrimal gland at the base of the aberrant cilia is directed by the same neuronal control as the normal lacrimal gland and functions with the same reflex secretion. The case presented by McCulley et al may in fact represent an anomalous lacrimal gland ductule, but with ectopic cilia there is also the possiblity of ectopic lacrimal gland tissue.

James R. Patrinely, MD; Ramon L. Font, MD; Charles N. S. Soparkar, MD
Houston, Tex

1. McCulley TJ, Yip CC, Kersten RC, Kulwin DR. An ectopic site of lacrimal gland secretion mimicking epiphora. Arch Ophthalmol. 2002;120:1586-1587. FREE FULL TEXT 2. Gordon AJ, Patrinely JR, Knupp JA, Font RL. Complex choristoma of the eyelid containing ectopic cilia and lacrimal gland. Ophthalmology. 1991;98:1547-1550. ISI | PUBMED

Arch Ophthalmol. 2004;122:791.