Eyelid papillomas are tumor–like neoplasms on the skin of the eyelid resulting from infection with the human papillomavirus. Usually papillomas are manifested only by a cosmetic defect, with some localizations, pain, foreign body sensation and other symptoms are possible. For diagnostics, visiometry, tonometry, refractometry, computer perimetry, biomicroscopy using a slit lamp are used. Of the additional methods, CT and biopsy are used, followed by histology of the material. Treatment of eyelid papilloma is the removal of the tumor using chemical or physical methods of destruction. It is mandatory to prescribe antiviral drugs.
General information
Eyelid papillomas are tumors of the integumentary epithelium of the skin of the accessory apparatus of the eye with varying degrees of dysplasia caused by the human papillomavirus. Most often, eyelid papillomas are benign tumors, malignancy is rarely observed. The share of such neoplasms accounts for 60-65% of all neoplasms of the eyelids. Most often (3.5 cases per 100,000 population), this pathology occurs in people living in equatorially located countries. In Australia, the prevalence is 1.9 cases per 100,000 population. In countries with temperate and subarctic climates, the disease is diagnosed less often. The age category of patients is over 30 years old, the average age of patients ranges from 45-60 years. Women get sick one and a half times more often than men.
Causes
The leading etiological factor provoking the development of papilloma of the eyelid is infection with human papillomavirus (HPV). There are more than 100 different types of papillomavirus. The human papillomavirus is tropic to the epidermis of the skin, transmitted by direct contact with the infected epithelium (most often there is a contact-household, 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, vitamin deficiency, frequent visits to the solarium, oncological diseases, smoking, alcohol consumption.
Pathogenesis
It is believed that the basal layer contains papillomavirus-sensitive cells and enough single virus particles to stimulate the development of eyelid papilloma. HPV is an obligate intracellular parasite, which is usually present in the episomal form, i.e. it is located in the cytoplasm of the cell. However, during reproduction, it can migrate to the core (integration).
The onset of integration (the formation of papilloma of the eyelid) is possible even after 20 years from the beginning of infection, the time of development of the disease is determined not only by the virus, but also by the presence of a hereditary predisposition of the patient in combination with other factors. Even while in the cytoplasm, the virus is able to produce intact viral particles. At this stage, the infection is often asymptomatic, highly contagious, can easily spread to other tissues and organs and cause the formation of eyelid papillomas.
The processes of virus replication, assembly of viral particles and their release from the cell are not fully established. In one cell, the virus can simultaneously exist both in the nucleus and in the cytoplasm. When the virus enters the host body, its cytoplasmic replication begins after penetration into the cells of the basal layer of the skin. In the keratinizing layer, there is an active release of mature viral particles from cells. These areas of the skin are dangerous with respect to contact infection.
Symptoms
The clinical picture of eyelid papilloma depends on the localization and features of the growth of education. The 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 growths on the surface. In the center is a vascular loop.
Usually they are asymptomatic, the patient turns to an ophthalmologist when there is an obvious cosmetic defect caused by an increase in the papilloma of the eyelid. When a neoplasm appears at the ciliary edge or on the border with the conjunctiva, the patient may complain of a pronounced pain syndrome, a feeling of a foreign body, blepharospasm, hyperemia, decreased vision. When blinking, the corneal is affected by the uneven surface of the eyelid papilloma, which leads to the appearance of these symptoms.
Complications
Complications occur when the papilloma is localized at 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. Characterized by the development of chronic sluggish conjunctivitis, blepharitis, corneal opacities. They can cause a violation of the growth of eyelashes, which leads to microtrauma of the cornea with the development of keratitis. The formation of ectropion causes the occurrence of erosion and ulcers of the cornea, visual impairment, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of the papilloma of the eyelid.
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, computer perimetry, biomicroscopy using a slit lamp. Of the additional methods, if necessary, optical coherence tomography or computed tomography is used (prescribed for multiple papillomas of various localizations), the material is taken for biopsy (using a fingerprint, scraping or slice), followed by histological examination. In some cases, consultation with a dermatologist is necessary.
Treatment
For the treatment of eyelid papilloma, chemical or physical methods of 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 using liquid nitrogen). The chemical method is based on the use of various keratolytic agents. The choice of treatment option depends on the localization and prevalence of the neoplasm, the age of the patient. The prognosis is more often favorable.
Prevention
Preventive measures are aimed at reducing the risk of infection with the human papillomavirus. Mandatory use of condoms in case of accidental sexual contact is recommended. In case of detection of signs of HPV infection, examination of all sexual partners of the patient and the appointment of adequate treatment is required. To reduce the risk of the formation of papilloma of the eyelids, it is necessary to carry out measures to maintain immunity, not to touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and actively engage in sports. Refusing to visit a solarium significantly reduces the risk of eyelid papilloma.
