Months of Eyelid Swelling, Then Two White Protrusions

The patient was a 16-year-old boy from India who developed painless swelling in his upper left eyelid. The swelling lasted for several months before he noticed two sharp, white protrusions emerging from the skin above his eye.

About a month after the protrusions appeared, he went to the hospital. Doctors examined his eyelid and found that the surface of the spikes was “quite smooth and difficult to palpate.”

Dr. Meghana Tanwar, a medical consultant at Aravind Eye Hospital in India, told Live Science that the protrusions’ texture and color suggested they might be teeth.

CT Scans Revealed an Ectopic Tooth

Doctors initially considered several possibilities, including a teratoma—a rare type of tumor that can contain different kinds of tissue, including bone and teeth. They also considered whether a foreign object might be lodged in the eyelid.

A CT scan provided the answer. The imaging showed that the protrusion was part of a tooth.

“The single tooth structure in the upper orbit was very obvious,” Tanwar said. The upper orbit is the upper portion of the eye socket, located between the eyelid and eyebrow.

Teeth that develop or erupt in abnormal locations are called ectopic teeth. The term includes teeth that remain within the mouth but grow outside their usual position. For example, approximately 2% to 6% of people have first permanent molars that grow out of their expected arrangement.

In this case, however, the tooth developed completely outside the dental arch—an occurrence that is much rarer.

Surgeons Removed a Mature Canine Tooth

Doctors surgically removed the ectopic tooth from the boy’s eyelid. They identified it as a mature canine tooth and found no features suggesting that it was part of a teratoma.

Imaging did not reveal any other ectopic teeth, making it unlikely that the boy had another tooth growing elsewhere, Tanwar said.

A Tooth in the Upper Eye Socket Is Exceptionally Unusual

Ectopic teeth have been reported in unusual locations, including the nasal cavity and the lower part of the eye socket. Other case reports have described teeth in the nostril, chin and maxillary sinus.

But the location of this boy’s tooth was especially notable. “To our knowledge, this is the first and only ectopic tooth reported in the superior orbit,” Tanwar said.

“This was a first for us and for the whole world,” she added. “We were very surprised by it.”

Before this case, Tanwar had personally seen a tooth in the floor of another patient’s eye socket. That tooth was part of an odontogenic choristoma, a rare type of mass.

Why Did the Tooth Develop Near the Eye?

The underlying cause of the ectopic tooth in this teenager was unknown. In general, ectopic teeth may be associated with developmental disorders, physical trauma, infection or genetic factors.

This article is for informational purposes only and does not provide medical advice.

Topics: Diagnostic dilemma