Eyelid papillomas- tumor-like neoplasms on the skin of the eyelid, as a result of infection with the human papillomavirus. Usually, papillomas appear only as a cosmetic defect; in some localizations, pain, sensation of a foreign body and other symptoms are possible. For diagnostics, visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp are used. Of the additional methods, CT and biopsy are used, followed by histology of the material. Treatment of papilloma of the eyelids - removal of the tumor using chemical or physical methods of destruction. Prescription of antiviral drugs is mandatory.
Generel information
Eyelid papillomas are tumors in the integumentary epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia, caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignancy is rare. These neoplasms account for 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 per100, 000 inhabitants. In countries with a temperate and subarctic climate, the disease is diagnosed less often. The age category of patients is above 30 years, the average age of patients ranges from 45-60 years. Women get sick one and a half times more often than men.
The grounds
The leading etiological factor that provokes the development of eyelid papilloma is infection with the human papillomavirus (HPV). There are over 100 different types of papillomavirus. 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, alcohol consumption.
Pathogenesis
It is believed that in the basal layer there are cells that are sensitive to papillomavirus and enough individual particles of the virus to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite that is usually present in episomal form, i. e. located in the cytoplasm of the cell. But during reproduction it can migrate into the nucleus (integration).
The onset of integration (the formation of papilloma in the eyelids) is possible even after 20 years from the beginning of the infection, the time of the 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 in the cytoplasm, the virus is able to produce intact viral 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 viral particles and their release from the cell have not been fully established. In one cell, the virus can simultaneously exist both in the nucleus and in the cytoplasm. When the virus enters the host organism, its cytoplasmic replication begins after penetrating the cells of the basal layer of the skin. In the stratum corneum there is an active release of mature virus particles from cells. These areas of the skin are dangerous in terms of contact infection.
Symptoms of eyelid papilloma
The clinical picture of eyelid papilloma depends on the location and the characteristics of the growth of education. Size, color, shape and growth pattern can vary greatly. Most often, papillomas are located on the lower eyelid and do not affect visual acuity. They are characteristic exophytic formations of a grayish-yellow color with papillary growths on the surface. In the middle is a vascular loop.
Usually they are 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 of the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia and reduced vision. When you blink, the cornea is damaged by the uneven surface of the eyelid papilloma, which leads to the onset of these symptoms.
Complications
Complications occur when the papilloma is localized at the ciliary edge of the eyelids, in the intermarginal space, in the area of the inner corner of the eye, and also when the neoplasm spreads to the conjunctiva. Characterized by the development of chronic indolent conjunctivitis, blepharitis, corneal opacities. They can cause eyelash growth disorders, leading to microtrauma in the cornea with the development of keratitis. The formation of ectropion causes the appearance of erosion and ulceration of the cornea, reduced visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of eyelid papilloma.
Diagnostics
Diagnosis of eyelid papilloma begins with an examination 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. Of the additional methods, if necessary, optical coherence tomography or computed tomography (designated for multiple papillomas of various localizations) is used, material is taken for a biopsy (using an impression, scraping or cut), followed by a histological examination. In some cases, consultation with a dermatologist is necessary.
Treatment of papillomas in the eyelids
For the treatment of papilloma in the eyelids, chemical or physical methods are used to destroy the neoplasm. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include the removal of eyelid papilloma using 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 favorable.
Prevention
Preventive measures are aimed at reducing the risk of infection with the human papillomavirus. Forced use of condoms during casual sex is recommended. If signs of HPV infection are detected, an examination of all the patient's sexual partners and appointment of appropriate treatment is required. To reduce the risk of the formation of eyelid papilloma, it is necessary to take measures to maintain immunity, not 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 papillomas of the eyelids.