 It took me seven years to get excited about this case. When I first saw it with Jeff Petty, he was excited about it immediately. I don't know why, but I thought of it this last week when we were doing it, thinking about these cases. So I'm going to present just a 44-year-old male who was sent to Jeff's clinic for a neoplasm referral from a local optometrist. So 44-year-old with a soft contact lens whereas I had been read for it would kind of come and go. But over the last week, it kind of just started to get worse. They noted that he had like this large area in by his nose, and the optometrist kind of noted about a 10 by 5 area of redness. And then there was kind of a white plaque on the surface of this area of redness. As an intern, when I saw this patient, I was kind of drilling him on the contact lens where he did wear his contacts for a long time, like two months at a time. But he did take him out every night. So he was a pretty reasonable contact lens where his vision was fine. He was 20, 20. His pressure was normal. All of his motility and all that stuff was also normal. So on his exam, he had about a 2 by 1 millimeter area of whitening on the conjunctiva that had stain uptake. And it was overlying a larger area of whitening and then surrounded by a lot of injection. And so this is a clinical photo of him. I love our photography department. I think you guys are excellent at giving us good photos. So if you look up here, you can see kind of this area of whitening. And then there's a lot of redness kind of surrounding. And way over here on this side, we get a better photo of it here in a second. You can see this patch here that the optometrist was worried about was potentially something neoplastic. So that's what the patient was referred over for. So you can see just another photo of it. You can appreciate just that this area was actually ulcerated, so there was stain uptake here. And then this whole area was kind of white in appearance and just lots of injection and irritation. And so I was kind of thinking, OK, what is this? Could this be a CIN? It's kind of weird in that age group. This guy did a lot of outdoor stuff, but really young for a neoplasm. Is this something inflammatory and episcleritis or vasculitis of some kind? Is it an infection? He wears contact. So this could be a conjunctival infection or ulceration. Or is there some sort of a foreign body in there that's causing the issues? And so if you look really closely at this external photo, what you'll see here is there's actually a hair, a cilium, kind of right in the upper punctum. And it's kind of a weird hair follicle or hair shaft because it's pretty ruddy. It's pretty thick. It's definitely not an eyelash. And as you kind of look closer at it, it just has a really blunt edge on it. And it had been rubbing kind of on that conjunctiva this whole time. And so you can see how thick that is. So a little bit more history from him. I found out that he had been on a recent backpacking trip and had grown a really long beard. This is over a couple of weeks. And he came home and shaved his beard and ended up with one of his beard shaft hairs and one of his punctums. So Jeff put him on some Tobor Dex and he came back a couple of weeks later and he was feeling great. It hadn't quite all gone away, but it healed up pretty nicely. So kind of random about this. Literally that weekend, I did the same thing. I had shaved. And I actually felt some irritation within the mirror. And I actually had one in my punctum, a little hair in there. It was like the craziest thing. And I text Jeff. It was on a Sunday afternoon. He's like, dude, why are you texting me? But it was the exact same thing happening. Why are you shaving? Yeah. So Dr. Patel has really, he's kind of really the only one, honestly, in the literature that has written extensively on eyelashes and just hair, foreign body, and issues around the eye. And there's a lot of actually really good information out there from him. And the term that's kind of been coined for this is a pseudosilium. So you essentially have a hair that's not really in the place that it should be. And this is either if it's stuck in a maybomian gland, which I've seen a few times as well, and then also in the punctum, is kind of where this term comes from. And it's kind of interesting because he kind of describes it as an upside down lash. And so there's something with the pumping mechanism of that and the vacuum forces that will pull that lash in or the hair in thin side first. And so you'll have that thick end sticking out of the punctum or the maybomian gland. So just a couple other, this is the only case report that's written in the literature of the same thing. And it was, I can't even remember the year, I apologize, it's in my references, but a 43 year old female haircut, same thing. Ended up with a little hair right in there. See how good our photos are compared to theirs? We just have really good photographers. And then these are kind of a couple of crazy cases. This was a finance clerk who had a metal foreign body in the upper punctum. I don't even know what that is. I don't know if it's like a piece of a staple or something. But then also another clerk of some kind with a foreign body in the punctum. This was out of India. And another, like these are two cases of metal foreign bodies. So you can have a bunch of different foreign bodies in the punctum. So obviously we put some in so the puncto plugs, they can cause kind of a similar thing if that silicone plug is sticking up or the collagen plugs. And then these tubes that we put in and other random things. So that's the quick case that I presented. If you seriously don't know all the different ways that lashes can cause issues, I would get into this, it's kind of an interesting thing. I've never even seen it before. It's called stat pearls. Dr. Patel has written a couple of articles in there. And it's just, it's literally like an encyclopedia of every lash issue that you can have. So that's my case. So just examine the patient, look at their eyelids, make sure the lashes are all in place. If you've got photosensitivity, foreign bodies, redness, all that kind of stuff. Thank you.