Eyelid papillomas- tumor-like neoplasms on the skin of the eyelid, resulting from infection by the human papilloma virus. Usually, papillomas appear only as a cosmetic defect; in some locations, 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 histology of the material. Treatment of papilloma of the eyelids - removal of the tumor by chemical or physical destruction methods. The prescription of antiviral drugs is mandatory.
General information
Palpebral papillomas are tumors of the integumentary epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia, caused by the human papilloma virus. Most often, papillomas of the eyelids are benign tumors, malignancy is rare. These neoplasms represent 60 to 65% of all eyelid neoplasms. More frequently (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 inhabitants. In countries with a temperate and subarctic climate, the disease is diagnosed less frequently. The age category of patients is older than 30 years, the average age of patients ranges from 45 to 60 years. Women get sick one and a half times more than men.
The reasons
The main etiological factor that causes the development of palpebral papilloma is infection by the human papilloma virus (HPV). There are more than 100 different types of papillomavirus. The human papillomavirus is tropic for the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (most often there is domestic contact, less often sexual transmission). In addition, it can be transmitted from mother to fetus.
Factors contributing to the development of palpebral papilloma include genetic predisposition, immunological and hormonal disorders (diabetes mellitus, hyperthyroidism 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 sensitive to the papilloma virus and enough individual virus particles to stimulate the development of the papilloma of the eyelid. HPV is an obligate intracellular parasite that is usually present in an episomal form, that is, located in the cytoplasm of the cell. However, during playback, you can migrate to the kernel (integration).
The onset of integration (the formation of papilloma of the eyelids) is possible even after 20 years from the start of infection, the time of development of the disease is determined not only by the virus, but also by the presence of the hereditary predisposition of the patient. in combination 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 and cause papillomas on the eyelids.
The processes of virus replication, assembly of viral particles, and their release from the cell have not been fully established. In a cell, the virus can exist simultaneously in both the nucleus and the cytoplasm. When the virus enters the host organism, its cytoplasmic replication begins after penetrating the cells of the basal layer of the skin. In the stratum corneum, there is an active release of mature viral particles from cells. These areas of the skin are dangerous in connection with infection by contact.
Symptoms of papilloma of the eyelid
The clinical picture of the papilloma of the eyelid depends on the location and characteristics 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 a greyish-yellow color with papillary growths on the surface. In the center there is a vascular loop.
They are usually asymptomatic, the patient goes to the ophthalmologist if an evident aesthetic defect occurs due to an increase in the palpebral papilloma. When a neoplasm appears on the ciliary border 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 irregular surface of the eyelid papilloma damages the cornea, which causes the appearance of these symptoms.
complications
Complications arise when the papilloma is located 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. Characterized by the development of chronic lazy conjunctivitis, blepharitis, corneal opacities. They can cause eyelash growth disorders, which leads to microtrauma of the cornea with the development of keratitis. The formation of ectropion provokes the appearance of erosion and ulcers of the cornea, deterioration of visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of the papilloma of the eyelid.
Diagnosis
Diagnosis of papilloma of the eyelid 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, slit-lamp biomicroscopy. Of the additional methods, if necessary, optical coherence tomography or computed tomography (designated for multiple papillomas of various localizations) is used, material is taken for a biopsy (using an impression, scraping or cutting) followed by histological examination. . In some cases, consultation with a dermatologist is necessary.
Treatment of papillomas of the eyelids
For the treatment of papilloma of the eyelids, chemical or physical methods of destruction of the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Destructive physical methods include removal of the papilloma of the eyelid by 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 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 the human papillomavirus. The mandatory use of condoms during casual sexual intercourse is recommended. If signs of HPV infection are detected, an examination of all sexual partners of the patient and the appointment of adequate treatment are required. To reduce the risk of papilloma formation on the eyelids, it is necessary to take measures to maintain immunity, not touch your 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.