Papillomas of the eyelids- tumor-like neoplasms on the skin of the eyelids caused by infection with the human papillomavirus. Usually, papillomas appear only as a cosmetic defect, pain, foreign body sensation and other symptoms are possible in some locations. 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 eyelid papilloma - tumor removal using chemical or physical destruction methods. A prescription for antiviral medication is mandatory.
Main information
Papillomas of the eyelids are epithelial tumors of the adnexal apparatus of the eye caused by the human papillomavirus with varying degrees of dysplasia. Most often, eyelid papillomas are benign tumors, malignant tumors are rare. These neoplasms account for 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 countries with a temperate and subarctic climate, the disease is diagnosed less often. The age category of patients is over 30 years, the average age of patients ranges from 45-60 years. Women get sick one and a half times more often than men.
Reasons
The main etiological factor that provokes the development of eyelid papilloma is infection with the human papillomavirus (HPV). There are more than 100 different types of papillomavirus. The human papilloma virus is tropic for the epidermis of the skin, it is transmitted through direct contact with the infected epithelium (most often household contact, less often sexual transmission). In addition, it can be transmitted from mother to fetus.
Factors contributing to the development of eyelid papilloma are 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 sensitive to papillomavirus and enough individual virus particles to stimulate the development of papilloma of the eyelids. HPV is an obligate intracellular parasite, usually present in an episomal form, i. e. i. , located in the cytoplasm of the cell. However, during reproduction it can migrate into the nucleus (integration).
The beginning of integration (formation of papilloma of the eyelids) 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 hereditary predisposition of the patient. in combination with other factors. Even in the cytoplasm, the virus is able to produce 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 papillomas.
The processes of viral replication, the assembly of viral particles and their release from the cell have not been fully elucidated. In one cell, the virus can simultaneously exist both in the nucleus and in the cytoplasm. When the virus enters the host, after entering the cells of 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 due to contact infection.
Symptoms of eyelid papilloma
The clinical picture of papilloma of the eyelids depends on the place of growth and characteristics of 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 grayish-yellow exophytic formations with papillary growths on the surface. In the center is a vascular loop.
They are usually asymptomatic, the patient turns to an ophthalmologist if an obvious cosmetic defect occurs due to an increase in papilloma of the eyelids. 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 visual impairment. When you blink, 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 localized on the ciliary edge of the eyelids, in the intermarginal space, in the region of the inner corner of the eye, as well as when the tumor spreads to the conjunctiva. Characteristic development of chronic sluggish conjunctivitis, blepharitis, clouding of the cornea. They can cause eyelash growth disorders that lead to corneal microtrauma with the development of keratitis. The formation of ectropion causes corneal erosions and ulcers, visual impairment, up to atrophy of the eyeball. In addition, there is always a risk of eyelid papilloma malignancy.
Diagnostics
The diagnosis of eyelid papilloma begins with an ophthalmologist's survey and a visual examination of the patient. 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 (prescribed for several papillomas of different localization), material is taken for biopsy (using a print, scraping or cut), followed by histological examination. In some cases, consultation with a dermatologist is necessary.
Treatment of eyelid papillomas
For the treatment of papilloma of the eyelids, chemical or physical methods of destroying the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include removal of eyelid papilloma using electrocoagulation, laser therapy, cryotherapy (destruction of the tumor 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 spread 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. It is recommended to use condoms during daily sexual intercourse. If signs of HPV infection are detected, it is necessary to examine all the patient's sexual partners and prescribe adequate treatment. To reduce the risk of developing papillomas of the eyelids, it is necessary to take measures to maintain immunity, do not touch the eyes with dirty hands, follow a healthy lifestyle, avoid excessive work and do active sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.