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Letter to the Editor
Conjunctival and lacrimal sac pigmentation by kohl (eyeliner)
  1. AHMED A HIDAYAT
  1. Armed Forces Institute of Pathology, Washington DC, USA
  2. Armed Forces Institute of Pathology, Washington DC, USA
  1. ROBERT G WEATHERHEAD,
  2. ALI AL-RAJHI, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
  1. Armed Forces Institute of Pathology, Washington DC, USA
  2. Armed Forces Institute of Pathology, Washington DC, USA
  1. FRANK B JOHNSON
  1. Armed Forces Institute of Pathology, Washington DC, USA
  2. Armed Forces Institute of Pathology, Washington DC, USA
  1. Ahmed A Hidayat, MD, Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington DC 20306-6000, USA.

https://doi.org/10.1136/bjo.81.5.415d

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    Editor,—Abnormal pigmentation of the conjunctiva has been associated with various pathological conditions including melanosis, melanocytic tumours, foreign bodies, systemic disease, topical and systemic use of medications, and industrial exposure to various chemicals.1 2

    CASE REPORTS

    In this report, abnormal pigmentation of the conjunctiva and lacrimal sac was noted in 10 patients using kohl (eyeliner, surma) that was made in India.3-5 This eyeliner is used by millions in the Middle East, Asia, and Africa. The median age of nine women and one man was 52 years (range 40–64 years). All patients had used kohl for many years. The two patients with conjunctival pigmentation had bilateral, diffuse pigmentation of the fornicial and tarsal conjunctiva of the upper and lower eyelids in the form of discrete, punctate black deposits (Fig 1). The other eight patients presented with epiphora and had chronic dacryocystitis associated …

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