Eyelid papilloma- tumor-like neoplasms on the skin of the eyelids, as a result of human papillomavirus infection. Usually, papilloma appears only as a cosmetic defect; in some localization, pain, foreign body sensation, 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. Eyelid papilloma treatment - tumor removal using chemical or physical destruction methods. Antiviral medication prescription is mandatory.
General information
Eyelid papilloma is a tumor of the integumentary epithelium of the adnexal apparatus of the eye with various degrees of dysplasia, caused by the human papillomavirus. Most often, eyelid papilloma is a benign tumor, malignancy is rare. This neoplasia accounts for 60-65% of all eyelid neoplasms. 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, this disease is diagnosed less often. The patient age category is over 30 years old, the average patient age is between 45-60 years old. 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 human papillomavirus (HPV). There are over 100 different types of papillomavirus. Human papillomavirus is tropic to the epidermis of the skin, it is transmitted through direct contact with the infected epithelium (most often there is household contact, less often sexual transmission). In addition, it can be transmitted from mother to fetus.
Factors that contribute 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 that a single particle of the virus is enough to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite that is usually found in episomal form, that is, located in the cytoplasm of cells. However, during reproduction, it can migrate into the nucleus (integration).
The beginning of integration (formation of eyelid papilloma) is possible 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 hereditary predisposition of the patient. combined with other factors. Even in the cytoplasm, the virus is capable of producing 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 papilloma.
The process of virus replication, assembly of virus particles and their release from the cell has not been fully established. In one cell, the virus can simultaneously exist 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. This area of the skin is dangerous in relation to contact infection.
Symptoms of eyelid papilloma
The clinical picture of papilloma of the eyelid depends on the location and characteristics of educational growth. 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 yellow-gray color with papillary growth on the surface. In the middle is the vascular loop.
Usually they are asymptomatic, the patient turns to an ophthalmologist if a clear cosmetic defect occurs due to an increase in eyelid papilloma. When the neoplasm appears on the ciliary edge 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 onset of these symptoms.
Complications
Complications arise when the papilloma is localized on the ciliary edge of the eyelid, in the intermarginal space, in the inner corner of the eye, and also when the neoplasm spreads to the conjunctiva. Characterized by the development of chronic moist conjunctivitis, blepharitis, corneal opacity. They can cause eyelash growth disorders, leading to corneal microtrauma with the development of keratitis. The formation of ectropion causes the occurrence of erosion and ulceration of the cornea, impaired visual function, until the atrophy of the eyeball. In addition, there is always a risk of eyelid papilloma malignancy.
Diagnostics
The 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, biomicroscopy with a slit lamp. From additional methods, if necessary, optical coherence tomography or computed tomography is used (appointed for various papillomas of various localization), material is taken for biopsy (using tracks, scraping or cutting) followed by histological examination. In some cases, consultation with a dermatologist is necessary.
Eyelid papilloma treatment
For the treatment of eyelid papilloma, chemical or physical methods of neoplasm destruction are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Methods of physical destruction include the removal of eyelid papillomas using electrocoagulation, laser therapy, cryotherapy (destruction of neoplasms with liquid nitrogen). Chemical methods are based on the use of various keratolytic agents. The choice of treatment options 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 infection with human papillomavirus. Mandatory condom use during casual sex is recommended. If signs of HPV infection are detected, examination of all sexual partners of the patient and appointment of adequate treatment is required. To reduce the risk of eyelid papilloma formation, it is necessary to take measures to maintain immunity, not touch the eyes with dirty hands, lead a healthy lifestyle, avoid too much work and actively play sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.