A 26-year-old woman with a limbal dermoid

A 26-year-old woman presented to a dermatologist’s office for psoriasis, reporting discomfort due to itching and scaling. During the consultation, we incidentally noticed a smooth, yellow–white, well-circumscribed, hair-bearing nodule at the corneoscleral limbus of the patient’s right eye, which had been present since birth (Figure 1). She did not have any ocular symptoms, and the nodule did not affect her visual axis. She had no craniofacial, auricular, or vertebral anomalies suggestive of oculo–auriculo–vertebral spectrum (OAVS) diseases. Her family history was unremarkable for related conditions. Based on the appearance of the lesion, we diagnosed a limbal dermoid. As the patient described the nodule as not bothersome, she declined surgical management. Thus, we provided education on its benign nature and counselled her that we would arrange consultation with an ophthalmologist if further symptoms developed, such as irritation, growth, visual changes, or cosmetic concerns.

Figure 1:

(A) Right eye of a 26-year-old woman with a congenital limbal dermoid. (B) A closer view highlights hair growth on the lesion.

Limbal dermoids are rare ectopic skin lesions with adnexal elements (e.g., hairs, glands) on the ocular surface. Their epithelium shows features of both hair epidermal and limbal epithelial stem cells, underscoring the shared developmental pathways across the eye and skin.¹ Hence, limbal dermoids reflect disordered interactions between the surface ectoderm and cranial neural crest at the corneoscleral junction. Most cases are isolated and sporadic, but limbal dermoids that occur with microtia or hemifacial microsomia and vertebral defects are considered an OAVS disease, representing a clinically and genetically heterogeneous condition (e.g., Goldenhar syndrome), and patients should be referred to an otolaryngologist and ophthalmologist for further assessment.² Observation of limbal dermoids is appropriate when vision is unaffected. Surgery, which typically involves lamellar excision with ocular surface reconstruction, can be considered for patients with visual axis encroachment, induced astigmatism, chronic irritation, or cosmesis, but management should be individualized and goal directed.³ Clinicians — including general practitioners, dermatologists, and ophthalmologists — should recognize hair-bearing ocular surface lesions and, when appropriate, advise specialist referral and surgical intervention.