Cutaneous horns of the eyelid are uncommon lesions, particularly in young individuals, and may arise from a spectrum of underlying pathologies ranging from benign to malignant. ^, We report the case of a 14-year-old girl who presented with a slowly progressive keratinous projection at the medial canthus of the right lower eyelid for 5 years. The lesion measured 7 mm × 1 mm and did not involve the lacrimal punctum ( Figure 1 ).

Clinical photograph revealing a conical, keratinous projection arising from the medial canthus of the right lower eyelid, located just lateral to the lower punctum, consistent with a cutaneous horn.

Complete excisional biopsy with 1-mm margins was performed under local anesthesia with careful preservation of the lacrimal drainage system ( Figure 2 , A and B). Histopathologic analysis revealed an acrochordon (fibroepithelial polyp), a polypoid lesion composed of fibrovascular connective tissue lined by stratified squamous epithelium, without atypia, dysplasia, or malignancy ( Figure 3 ).

A. Intraoperative view demonstrating surgical excision of a medial canthal lesion of the right lower eyelid, performed with meticulous dissection to avoid injury to the lower punctum and canaliculus. B. The excised specimen was measured with a scale.

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