Eyelid papillomas- tumor-like growths on the skin of the eyelids resulting from human papillomavirus infection. Papillomas usually appear only as a cosmetic defect, pain, foreign body sensation and other symptoms are possible in some localizations. Visiometry, tonometry, refractometry, computerized perimetry, and slit-lamp biomicroscopy are used for diagnostics. Among other methods, CT and biopsy are used, followed by the histology of the material. Treatment of papilloma of the eyelids - removal of the tumor by chemical or physical methods of destruction. Prescription of antiviral drugs is mandatory.
general information
Eyelid papillomas are tumors of the integumentary epithelium of the eye's conjunctiva with varying degrees of dysplasia caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignant tumors are rare. These neoplasias account for 60-65% of all eyelid tumors. Most often (3. 5 cases per 100, 000 inhabitants) this pathology occurs in people living in equatorial countries. In Australia, the prevalence is 1. 9 cases per 100, 000 population. In countries with a temperate and subarctic climate, the disease is diagnosed less often. The age group of the patients is over 30 years old, the average age of the patients is between 45 and 60 years. Women get sick one and a half times more often than men.
The reasons
Human papillomavirus (HPV) infection is the leading etiological factor causing the development of eyelid papilloma. There are more than 100 different types of papillomavirus. The human papillomavirus is tropic and spreads to the skin's epithelial layer by direct contact with infected epithelial tissue (most often by household contact, less often by sexual contact). In addition, it can also be transmitted from mother to fetus.
Factors contributing to the development of eyelid papilloma include genetic predisposition, immunological and hormonal disorders (diabetes, hyper- or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that the basal layer contains papillomavirus-susceptible cells and sufficient viral particles to stimulate eyelid papilloma formation. HPV is an obligate intracellular parasite that is usually present in an episomal form, i. e. located in the cytoplasm of the cell. However, during reproduction, it can migrate into the nucleus (integration).
Integration (formation of papilloma of the eyelids) is possible even after 20 years from the beginning of the infection, the time of development of the disease is determined not only by the virus, but also by the presence of the patient's hereditary predisposition. combined with other factors. The virus is able to produce intact virus particles even in the cytoplasm. At this stage, the infection is often asymptomatic, highly contagious, can easily spread to other tissues and organs, and can cause eyelid papillomas.
The processes of virus replication, the assembly of virus particles and their release from the cell are not yet fully understood. In a cell, the virus can exist simultaneously both in the nucleus and in the cytoplasm. When the virus enters the host, its cytoplasmic replication begins after penetrating the cells of the basal layer of the skin. In the stratum corneum, the mature virus particles are actively released from the cells. These skin areas are dangerous for contact infection.
Symptoms of eyelid papilloma
The clinical picture of papilloma of the eyelid depends on the location and characteristics of the growth of the education. Size, color, shape and growth pattern can vary greatly. Most often, papillomas are localized on the lower eyelid and do not affect visual acuity. Characteristic gray-yellow exophytic formations with papillary growths on their surface. In the center is a vascular loop.
They are usually asymptomatic, the patient turns to an ophthalmologist if an obvious cosmetic defect occurs due to the growth of eyelid papilloma. When a tumor appears on the ciliary edge or conjunctival border, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and reduced vision. When you blink, the cornea is damaged due to the uneven surface of the eyelid papilloma, which leads to the appearance of these symptoms.
Complications
Complications occur if the papilloma is localized on the ciliary edge of the eyelids, in the intermarginal space, in the region of the inner corner of the eye, and also if the neoplasm spreads to the conjunctiva. It is characterized by the development of chronic, indolent conjunctivitis, blepharitis, and corneal opacities. They can cause eyelash growth disorders, which leads to microtrauma of the cornea with the development of keratitis. The formation of ectropion causes corneal erosion and ulcers, visual impairment, and even atrophy of the eyeball. In addition, there is always the risk of a malignant tumor of the eyelid papilloma.
Diagnostics
The diagnosis of eyelid papilloma begins with the assessment and visual examination of the patient by an ophthalmologist. Then the doctor uses standard examination methods: visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp. Among other methods, if necessary, optical coherence tomography or computer tomography is used (for multiple papillomas of different localization), a biopsy is taken (by impression, scraping or cutting), and then a histological examination is performed. In some cases, a dermatologist consultation is necessary.
Treatment of eyelid papillomas
For the treatment of papillomas of the eyelids, chemical or physical methods are used to destroy the neoplasm. At the same time, antiviral drugs with an immunomodulatory effect are prescribed. Physical destructive methods include removal of eyelid papilloma with electrocoagulation, laser therapy, cryotherapy (destruction of the tumor with liquid nitrogen). The chemical method is based on the use of various keratolytic agents. The choice of treatment option depends on the location and prevalence of the neoplasm, as well as the patient's age. The prognosis is often favorable.
Prevention
The purpose of preventive measures is to reduce the risk of infection with human papillomavirus. Mandatory condom use is recommended during casual sex. If signs of HPV infection are detected, it is necessary to examine all the patient's sexual partners and prescribe appropriate treatment. To reduce the risk of developing eyelid papilloma, measures should be taken to maintain immunity, do not touch the eyes with dirty hands, maintain a healthy lifestyle, avoid overexertion and do active sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.