Papillomas of the eyelids- tumor-like neoplasms on the skin of the eyelid, resulting from infection with the human papillomavirus. Usually, papillomas only appear as a cosmetic defect; in some localizations, pain, foreign body sensation and other symptoms are possible. For diagnosis, visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp are used. Of the additional methods, computed tomography and biopsy are used, followed by histology of the material. Treatment of eyelid papilloma - removal of the tumor using chemical or physical methods of destruction. The prescription of antivirals is mandatory.
general informations
Eyelid papillomas are tumors of the integumentary epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia, caused by the human papilloma virus. Most often eyelid papillomas are benign tumors, malignancy is rare. These neoplasias represent 60-65% of all eyelid neoplasms. 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 frequently. The age category of patients is over 30 years old, the average age of patients ranges from 45 to 60 years old. 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 infection with human papillomavirus (HPV). There are over 100 different types of papillomaviruses. The human papillomavirus is tropic to the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (most often there is contact-household, less often sexual transmission). In addition, 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, consumptionof alcohol.
Pathogenesis
It is believed that in the basal layer there are cells susceptible to papillomavirus and enough individual particles of the virus to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite generally present in episomal form, ie located in the cytoplasm of the cell. However, during reproduction, it can migrate into the nucleus (integration).
The onset of integration (the formation of an eyelid papilloma) is possible even 20 years after the onset of infection, the timing of the development of the disease is determined not only by the virus, but also by the presence ofthe hereditary predisposition of the patient in combination with other factors. Even in the cytoplasm, the virus is able to produce 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 viral replication, assembly of viral particles and their release from the cell have not been fully established. In a cell, the virus can exist simultaneously both in the nucleus and in the cytoplasm. 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 virus particles from the cells. These areas of the skin are dangerous in case of contact infection.
Eyelid papilloma symptoms
The clinical picture of eyelid papilloma depends on the location and features of the growth of 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. These are characteristic exophytic formations of a grayish-yellow color with papillary growths on the surface. In the center is a vascular loop.
Usually asymptomatic, the patient turns to an ophthalmologist if an obvious cosmetic defect occurs due to an increase in eyelid papilloma. When a neoplasm appears at the ciliary edge or at the border with the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia and decreasedvision. When blinking, the cornea is damaged by the uneven surface of the eyelid papilloma, which leads to the appearance 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, as well as when the neoplasm spreads to the conjunctiva. Characterized by the development of slow chronic conjunctivitis, blepharitis, corneal opacities. They can cause eyelash growth disorders, which leads to microtraumas of the cornea with the development of keratitis. The formation of ectropion provokes the appearance of erosions and ulcers of the cornea, impaired visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of eyelid papilloma.
Diagnostic
Diagnosis of eyelid papilloma begins with a survey and visual examination of the patient by an ophthalmologist. Then, the doctor uses classic examination methods: visiometry, tonometry, refractometry, computerized perimetry, slit lamp biomicroscopy. Of the additional methods, if necessary, optical coherence tomography or computed tomography is used (appointed for several papillomas of different localizations), material is taken for biopsy (using an impression, scraping orsection) 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 immunomodulating activity are prescribed. Methods of physical destruction include removal of eyelid papilloma by electrocoagulation, laser therapy, cryotherapy (destruction of 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 favorable.
Prevention
Preventive measures are aimed at reducing the risk of infection with the human papillomavirus. 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 eyelid papilloma formation, it is necessary to take measures to maintain immunity, do not touch your eyes with dirty hands, lead a healthy lifestyle, avoid overstrain and actively play sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.