eyelid papillomas- tumor-like neoplasms on the skin of the eyelid, caused by human papillomavirus infection. Often papillomas appear only as a cosmetic defect, in some localizations pain, foreign body sensation and other symptoms are possible. For diagnosis, visiometry, tonometry, refractometry, computerized perimetry, slit lamp biomicroscopy are used. Of the additional methods, CT and biopsy are used, followed by the 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.
general information
Eyelid papillomas are tumors of varying degrees of dysplasia of the integumentary epithelium of the adnexal apparatus of the eye, caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignancy is rare. These neoplasms constitute 60-65% of all eyelid neoplasms. Most often (3. 5 cases per 100, 000 population) this pathology occurs in people living in equatorial countries. The prevalence in Australia 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 and the average age of the patients varies between 45-60 years. Women get sick one and a half times more often than men.
Causes
The leading etiological factor provoking the development of eyelid papilloma is infection with the human papillomavirus (HPV). There are more than 100 different types of papillomaviruses. The human papillomavirus is tropic to the epidermis of the skin, transmitted by direct contact with the infected epithelium (most often there is domestic contact, less often sexual transmission). It can also be transmitted from mother to fetus.
Factors contributing to the development of eyelid papilloma include genetic predisposition, immunological and hormonal disorders (diabetes, hyper- or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to the solarium, cancer, smoking, alcohol consumption.
pathogenesis
It is believed that the basal layer contains cells susceptible to papillomavirus and sufficient single virus particles to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite that is usually found in episomal form, that is, in the cytoplasm of the cell. However, it can migrate to the nucleus during reproduction (integration).
The onset of integration (the formation of papillomas of the eyelids) is possible even 20 years after 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. along with other factors. Even while in the cytoplasm, the virus can produce intact viral particles. At this stage, the infection is usually asymptomatic, highly contagious, and can easily spread to other tissues and organs, causing eyelid papillomas.
The processes of virus replication, association of viral particles and their release from the cell have not been fully determined. In a cell, the virus can be present in both the nucleus and the cytoplasm at the same time. When the virus enters the host organism, after penetrating the cells in the basal layer of the skin, its cytoplasmic replication begins. In the stratum corneum there is an active release of mature viral particles from the cells. These areas of the skin are dangerous for contact infection.
Eyelid papilloma symptoms
The clinical picture of the eyelid papilloma depends on the location and features 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 exophytic formations of grayish yellow color with papillary growth on the surface. In the center is a vascular ring.
They are usually asymptomatic, if an obvious cosmetic defect occurs due to the increased eyelid papilloma, the patient consults an ophthalmologist. When a neoplasm appears on the ciliary margin or conjunctival border, 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 onset of these symptoms.
Complications
Complications arise when the papilloma spreads on the ciliary edge of the eyelids, in the intermarginal space, in the area of the inner corner of the eye, as well as when the neoplasm spreads to the conjunctiva. It is characterized by the development of chronic sluggish conjunctivitis, blepharitis, corneal opacities. They can cause eyelash growth disorders that lead to microtrauma of the cornea with the development of keratitis. The formation of ectropion leads to the formation of erosion and ulcers in the cornea, impaired vision, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of the eyelid papilloma.
Diagnosis
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, slit lamp biomicroscopy. If necessary, additional methods of optical coherence tomography or computed tomography are used (assigned for multiple papillomas of various localizations), material for biopsy is taken (using pressure, scraping or cutting), followed by 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, methods of chemical or physical destruction of the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include removal of the 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 extent of the neoplasm, the age of the patient. The prognosis is generally favorable.
prevention
Preventive measures are aimed at reducing the risk of infection with the human papillomavirus. Mandatory condom use is recommended during casual sex. If signs of HPV infection are detected, an examination of all sexual partners of the patient and the appointment of adequate therapy are required. To reduce the risk of formation of eyelid papillomas, 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 papilloma of the eyelids.