Eyelid papillomas- tumor-like neoplasms on the skin of the eyelid, resulting from infection with the human papillomavirus. Usually papillomas appear only as a cosmetic defect, in some localizations pain, foreign body sensation and other symptoms are possible. For diagnostics, visiometry, tonometry, refractometry, computerized perimetry, slit lamp biomicroscopy are used. Among the additional methods, CT and biopsy are used, followed by histology of the material. Treatment of eyelid papilloma - removal of the tumor by chemical or physical methods of destruction. The prescription of antiviral drugs is mandatory.
General information
Palpebral papillomas are tumors of the integumentary epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia, caused by the human papillomavirus. Most often, eyelid papillomas are benign tumors, malignancy is rare. These malignancies account for 60-65% of all eyelid malignancies. 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 temperate and subarctic climates, the disease is diagnosed less frequently. The age category of patients is over 30 years old, the average age of patients ranges from 45 to 60 years. Women get sick one and a half times more often than men.
The reasons
The main etiological factor provoking the development of eyelid papilloma is human papillomavirus (HPV) infection. There are over 100 different types of papillomaviruses. The human papillomavirus is tropic to the epidermis of the skin, is transmitted by direct contact with the infected epithelium (most often there is family, less often sexual, contact transmission). Furthermore, it can be transmitted from mother to fetus.
Factors contributing to the development of eyelid papilloma include genetic predisposition, immunological and hormonal disorders (diabetes mellitus, hyper- or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that there are papillomavirus-sensitive cells and enough individual particles of the virus in the basal layer to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite that is usually present in the episomal form, ie localized in the cytoplasm of the cell. However, during reproduction, it can migrate to the nucleus (integration).
The onset of integration (the formation of eyelid papilloma) is possible even after 20 years from the onset of 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 in combination with other factors. Even while in the cytoplasm, the virus is capable of producing intact virus particles. At this stage, the infection is often asymptomatic, highly contagious, and can easily spread to other tissues and organs and cause eyelid papillomas.
The processes of virus replication, assembly of virus particles and their release from the cell have not been fully established. In a cell, the virus can exist in both the nucleus and the cytoplasm at the same time. When the virus enters the host organism, its cytoplasmic replication begins after penetration into the cells of the basal layer of the skin. In the stratum corneum there is an active release of mature viral particles from the cells. These areas of the skin are dangerous in relation to contact infection.
Symptoms of eyelid papilloma
The clinical picture of the eyelid papilloma 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. They are characteristic yellow-greyish exophytic formations with papillary growths on the surface. In the center is a vascular ring.
They are usually asymptomatic, the patient is referred to an ophthalmologist if an evident aesthetic defect occurs due to an increase in the eyelid papilloma. When a neoplasm appears at the ciliary edge or bordering the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and decreased vision. When she blinks, the cornea is damaged by the uneven surface of the eyelid papilloma, which leads to the occurrence of these symptoms.
Complications
Complications arise when 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 when the neoplasm spreads to the conjunctiva. Characterized by the development of chronic sluggish conjunctivitis, blepharitis, corneal opacities. They can cause eyelash growth disorders, which lead to microtrauma of the cornea with the development of keratitis. The formation of ectropion causes the occurrence of erosion and ulcers of the cornea, impaired visual function, up to atrophy of the eyeball. Also, there is always the risk of eyelid papilloma malignancy.
Diagnostics
Diagnosis of eyelid papilloma begins with a survey and visual examination of the patient by an ophthalmologist. Then the doctor uses standard methods of examination: visiometry, tonometry, refractometry, computer perimetry, slit lamp biomicroscopy. Of the additional methods, if necessary, optical coherence tomography or computed tomography is used (appointed for multiple papillomas of various localizations), the material is taken for a biopsy (using an impression, scraping or cutting) followed by histological examination . In some cases, a consultation with a dermatologist is necessary.
Treatment of eyelid papillomas
For the treatment of eyelid papilloma, chemical or physical methods of destruction of the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include the removal of the eyelid papilloma by electrocoagulation, laser therapy, cryotherapy (destruction of the neoplasm 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, the age of the patient. The prognosis is often good.
Prevention
Preventive measures are aimed at reducing the risk of human papillomavirus infection. Mandatory use of condoms during casual sex is recommended. If signs of HPV infection are detected, an examination of all sexual partners of the patient and the appointment of adequate treatment are necessary. To reduce the risk of the formation of eyelid papilloma, it is necessary to take measures to maintain immunity, not to touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and actively play sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.