The True Identity of a
Chalazion-like Mass

BY RALPH SALAZAR, O.D., AND GAMALIEL VILANOVA, M.D.
JAN. 1997

This 40-year-old keratoconus patient lived 500km away from our office in Caracas, Venezuela. He had been wearing PMMA contact lenses for more than 18 years, but had not been examined by an eye doctor for the last 10 years. He lost his contact lenses and requested replacements from us by telephone. We mailed him a new pair and urged him to come in for an examination.

THE MIGRATING LENS

When at last this patient came to be examined, he presented with what appeared to be a chalazion on the superior lid of his left eye (Fig. 1). When we everted the eyelid, however, we saw a hard, round, concave protuberance under the palpebral conjunctiva that we suspected was a contact lens.

We speculated that the contact lens had entered the superior conjunctival sac zone (fornix) and stayed there for several years. During that time, it could have broken the conjunctiva of the eyelid and slipped inside. The contact lens probably moved downward and then introduced itself into the lid through the front of the tarsus, where it developed into a cyst.

FIG. 1: A CHALAZION- LIKE MASS ON THE SUPERIOR LID OF THE PATIENT'S LEFT  EYE.

FIG. 2: OPENING THE CONJUNCTIVA REVEALS ONLY THE TARSUS.

FIG. 3: THE CONTACT LENS IS DISCOVERED WITHIN THE LID.

FIG. 4: THE PMMA CONTACT LENS IS EXTRACTED FROM THE LID.

SEARCH & SEIZURE

We performed surgery on the lid to extract the contact lens. The lens was not visible under the palpebral conjunctiva. We saw only the tarsus as shown in Figure 2.

When we made an incision on the tarsus, a great quantity of pus was expelled, a characteristic typical of a chalazion. Later, after cleaning the wound, we discovered a rigid and green object (Fig. 3). There it was, a contact lens within the lid! We excised the adhesions and extracted the lens, which was in perfect condition except for a very small break in the edge (Fig. 4).

A UNIQUE FINDING

There have been numerous instances where a contact lens has been found under the palpebral conjunctiva that was encysted in the superior fornix of the conjunctiva. As far as we know, however, a case exactly like this has never been registered or published. We report here that a contact lens with a break in its edge was able to enter the superior lid by cutting through the fornix. What's even more remarkable is that the contact lens remained in this location for 12 years.

We realize that our diagnosis of an embedded contact lens was daring initially, but the final result gives us full satisfaction indeed. CLS

References are available upon written request to the editors at Contact Lens Spectrum. To receive this information via fax, call 1-800-239-4684 and request Document #20. (Be sure to have a fax number ready.)

Dr. Salazar is a clinical professor at the Contact Lens Clinic at the Instituto Universitario de Optometria. Dr. Vilanova is a clinical professor at the Ophthalmology Clinic at the Hospital Militar, Carlos Arvelo. Both are in private practice in Caracas, Venezuela.