eyelid papillomas- tumor-like neoplasms on the skin of the eyelid, resulting from human papillomavirus infection. Usually, papillomas appear only as a cosmetic defect; in some locations, 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, 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. The prescription of antiviral drugs is mandatory.
General information
Eyelid papillomas are tumors of the tegumentary 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 neoplasms represent 60-65% of all eyelid neoplasms. Most often (3. 5 cases per 100, 000 population) this pathology occurs in people living in equatorial countries. In Australia, the prevalence is 1. 9 cases per 100, 000 population. In temperate and subarctic countries, the disease is diagnosed less frequently. The age range of patients is over 30 years, 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 that causes the development of eyelid papilloma is human papillomavirus (HPV) infection. There are over 100 different types of papillomaviruses. Human papillomavirus is tropic for the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (most often there is domestic contact, 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 papillomavirus-sensitive cells and enough isolated virus particles to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite that is usually present in the episomal form, that is, located in the cytoplasm of the cell. However, during playback, it may migrate to the core (integration).
The onset of integration (formation of papilloma of the eyelids) 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 though it is in the cytoplasm, the virus is able to produce intact viral particles. At this stage, the infection is usually 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 a cell, the virus can exist simultaneously in the nucleus and 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 viral particles from cells. These skin areas are dangerous with regard to contact infection.
Symptoms of eyelid papilloma
The clinical picture of eyelid papilloma depends on the localization and 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 grayish-yellow color with papillary growths on the surface. In the center is a vascular loop.
They are usually asymptomatic, the patient turns to the ophthalmologist if an obvious cosmetic defect occurs due to an increase in the eyelid papilloma. When a neoplasm appears on the ciliary border or on the border with the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia and decreased vision. 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 located 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 slow conjunctivitis, blepharitis, 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 the occurrence of corneal erosion and ulcers, impairment of visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy from eyelid papilloma.
Diagnosis
Diagnosis of eyelid papilloma begins with a survey and visual examination of the patient by an ophthalmologist. Then the doctor uses standard examination methods: visiometry, tonometry, refractometry, computerized perimetry, slit-lamp biomicroscopy. Of the additional methods, if necessary, optical coherence tomography or computed tomography is used (indicated for multiple papillomas in various locations), the material is removed for biopsy (using impression, scraping or cutting) followed by histological examination. In some cases, consultation with a dermatologist is required.
Treatment of eyelid papillomas
For the treatment of eyelid papilloma, chemical or physical methods of destroying the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Destructive physical 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 usually favorable.
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 indication of appropriate treatment are required. To reduce the risk of forming eyelid papilloma, it is necessary to take measures to maintain immunity, not to touch your eyes with dirty hands, lead a healthy lifestyle, avoid overwork and actively play sports. Refusal to go to the solarium significantly reduces the risk of papilloma of the eyelids.