Eyelid papillomas- tumor-like neoplasms on the skin of the eyelid, resulting from infection with the human papillomavirus. Usually, papillomas are seen only as a cosmetic defect; in some localization, pain, foreign body sensation, and other symptoms are possible. For diagnostics, videometry, tonometry, refractometry, computerized perimetry, slit-lamp biomicroscopy are used. Of the additional methods, CT and biopsy are used, followed by histology of the subject. Treatment of papilloma of the eyelids - elimination of the tumor using chemical or physical methods of destruction. Antiviral drug prescription is mandatory.
General information
Eyelid papillomas are tumors of the integumentary epithelium of the adnexal apparatus of the eye with various degrees of dysplasia, caused by the human papilloma virus. Papillomas of the eyelids are often benign tumors, malignancy is rare. These neoplasias account for 60-65% of eyelid neoplasms. This pathology occurs more often (3. 5 cases per 100, 000 of the population) in people who live 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 category of the patients is over 30 years old, the average age of the patients is between 45-60 years. Women get sick one and a half times more often than men.
The reasons
The main etiological factor that triggers 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 (often family contact, less often sexual transmission). In addition, it can be transmitted from the mother to the fetus.
Factors that contribute to the development of eyelid papilloma include genetic predisposition, immunological and hormonal disorders (diabetes mellitus, hyperthyroidism or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that the basal layer contains cells that are sensitive to the papilloma virus and many individual particles of the virus to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite that is usually present in the episomal form, i. e. , located in the cytoplasm of the cell. However, during reproduction, it can be transferred into the nucleus (integration).
The onset of consolidation (papilloma formation of the eyelids) can occur 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. 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 involved in virus replication, assembly of viral particles and their release from the cell are not fully established. In a single cell, the virus can exist simultaneously in the nucleus and cytoplasm. Once the virus enters the host organism, its cytoplasmic replication begins after entering the cells of the basal layer of the skin. In the stratum corneum, there is an active release of mature viral particles from cells. These areas of the skin are dangerous for contact infection.
Symptoms of eyelid papilloma
The clinical picture of eyelid papilloma depends on the location and growth characteristics of the education. Size, colour, shape and growth pattern can vary greatly. Often, papillomas are localized on the lower eyelid and do not affect visual acuity. They are characteristic exophytic formations of gray-yellow color with papillary growth on the surface. In the middle is a vascular loop.
They are usually asymptomatic, the patient turns to an ophthalmologist if a clear cosmetic defect occurs due to an increase in the eyelid papilloma. When a neoplasm appears on the ciliary edge or at the border with the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and reduced vision. When blinking, the cornea is damaged due to the uneven surface of the papilloma of the eyelid, which causes these symptoms to develop.
Complications
Complications arise when the papilloma is localized on the ciliary edge of the eyelids, in the interstitial 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, causing microtrauma of the cornea with the development of keratitis. The creation of ectropion causes the occurrence of erosion and ulcers of the cornea, impairment of visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of eyelid papilloma.
Diagnostics
The 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: visometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp. Of the additional methods, if necessary, optical coherence tomography or computed tomography (intended for multiple papillomas of different localization) is used, material is taken for biopsy (using trace, scraping or cut) and subsequent histological examination. In some cases, it is necessary to consult a dermatologist.
Treatment of papillomas of the eyelids
For the treatment of papilloma of 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 different keratolytic agents. The choice of the 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. The mandatory use of condoms during casual sex is recommended. If signs of HPV infection are found, it is necessary to examine all the patient's sexual partners and prescribe adequate treatment. To reduce the risk of eyelid papilloma formation, it is necessary to take measures to maintain immunity, not to touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and play sports actively. Refusal to visit the solarium greatly reduces the risk of papilloma of the eyelids.