This nice little piece is hand carved of ivory. Both sides are engraved with very fine circle and dot designs known as Madras work. It's a form of scrimshaw work where black lacquer is flowed into the engraved designs. It's English and dates to the early 19th century.
Aside from a small chip at the edge on one side, the condition is excellent with no other damage. This one is especially nice because the maker went overboard on her ribbon decoration at the top. Usually there's just a tab or small bow. The silk cushion and bows are original and it's stuffed with emery powder. The cushion measures about 1" in diameter. A variety of ivory Madras work needlework tools are shown on p. 87 of Nerylla Taunton's book "Antique Needlework Tools and Embroideries".
Emeries were used to sharpen and polish the steel needles of the age. Emery powder is a fine grit and the needles were pushed in and out the cushion several times. It also removed rust.