Papilloma of the eyelid- tumor-like neoplasms on the skin of the eyelid 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 localizations. Visiometry, tonometry, refractometry, computerized perimetry, slit lamp biomicroscopy are used for diagnosis. CT and biopsy, then histology of the material are used as additional methods. Treatment of eyelid papilloma - removal of the tumor using chemical or physical destruction methods. The appointment of antiviral drugs is mandatory.
General Information
Papillomas of the eyelid are tumors of the integumentary epithelium of the accessory apparatus of the eye with various degrees of dysplasia caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignant tumors are rare. These neoplasias account for 60-65% of all eyelid neoplasms. 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 patients is over 30 years old, the average age of patients varies between 45-60 years. Women get sick one and a half times more often than men.
The reasons
Human papillomavirus (HPV) infection is the leading etiological factor leading to the development of eyelid papilloma. There are more than 100 different types of papillomavirus. The human papillomavirus is tropic to the epidermis of the skin, it comes into direct contact with the infected epithelium (in most cases it is transmitted by contact-household, less often sexually). In addition, it can be passed from mother to fetus.
Factors contributing to the development of papillomas of the eyelids include genetic predisposition, immunological and hormonal disorders (diabetes, hyper or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
The basal layer is believed to contain papillomavirus-susceptible cells and enough single particles of the virus to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite, usually in an episomal form, that is, located in the cytoplasm of the cell. But during reproduction, it can move to the nucleus (integration).
The onset of integration (formation of papillomas of the eyelids) is possible even 20 years after 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 genetic predisposition. along with other factors. The virus can even form intact viral particles while in the cytoplasm. At this stage, the infection is often asymptomatic, highly contagious and can easily spread to other tissues and organs, causing papilloma of the eyelids.
The processes of virus replication, accumulation of virus particles and their exit from the cell are not fully established. In a cell, the virus can be present both in the nucleus and in the cytoplasm at the same time. When the virus enters the host organism, after penetrating the cells of the basal layer of the skin, its cytoplasmic replication begins. There is an active release of mature viral particles from cells in the stratum corneum. These areas of the skin are dangerous due to contact infection.
Papilloma symptoms of the eyelid
The clinical picture of eyelid papilloma depends on the location and characteristics of the growth of the education. Size, color, shape and growth pattern can vary greatly. Most often, papillomas are localized in the lower eyelid and do not affect visual acuity. They are characteristic gray-yellow exophytic formations with papillary growths on their surface. In the center there is a vascular loop.
Usually they are asymptomatic, if an obvious cosmetic defect occurs due to the increase of papillomas of the eyelids, the patient consults an ophthalmologist. When a 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 reduced vision. When blinking, the cornea is damaged by the uneven surface of the papilloma of the eyelid, which causes the onset 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, and also when the neoplasm spreads to the conjunctiva. Chronic slow conjunctivitis, blepharitis, is characterized by the development of corneal transparency. They can cause a violation of the growth of eyelashes, which leads to corneal microtrauma with the development of keratitis. Occurrence of ectropion causes corneal erosion and ulcers, visual impairment, and even atrophy of the eyeball. In addition, there is always a risk of malignancy of eyelid papillomas.
Diagnostics
The diagnosis of papilloma of the eyelid 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, biomicroscopy with a slit lamp. Additional methods, if necessary, use optical coherence tomography or computed tomography (prescribed for multiple papillomas of different localization), biopsy material is taken (using print, scraping or cutting), then histological examination. In some cases, a consultation with a dermatologist is required.
Treatment of eyelid papillomas
For the treatment of papillomas 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 eyelid papilloma using electrocoagulation, laser therapy, cryotherapy (neoplasm destruction with liquid nitrogen). The chemical method is based on the use of various keratolytic substances. The choice of the treatment option depends on the location and spread of the neoplasm, and the age of the patient. The prognosis is often favorable.
Prevention
Preventive measures are aimed at reducing the risk of infection with human papillomavirus. Mandatory use of condoms is recommended during casual sex. If signs of HPV infection are detected, all sexual partners of the patient should be examined and adequate treatment prescribed. To reduce the risk of papilloma of the eyelids, it is necessary to take measures to protect immunity, not touch the eyes with dirty hands, lead a healthy lifestyle, avoid excessive work and play active sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.