Papilloma of the eyelid- tumor-like tumors on the skin of the eyelids caused by human papillomavirus infection. Usually, papillomas appear only as a cosmetic defect, in some localizations there may be pain, sensation of a foreign body and other symptoms. Visiometry, tonometry, refractometry, computer perimetry, biomicroscopy with a slit lamp are used for diagnostics. Additional methods include CT and biopsy, followed by histology of the material. Treatment of eyelid papilloma is to remove the tumor using chemical or physical destruction methods. Antiviral drugs are mandatory.
General information
Eyelid papilloma is a tumor of the integumentary epithelium of the accessory eye with various degrees of dysplasia caused by the human papillomavirus. Most often, papilloma of the eyelid is a benign tumor, malignant is rare. It accounts for 60-65% of new tumors. 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 rare. The age category of patients is over 30 years old, the average age of patients is 45-60 years old. Women are affected one and a half times more often than men.
Reasons
Human papillomavirus (HPV) is the main etiological factor that induces the development of papilloma of the eye. There are more than 100 types of papillomavirus. Human papillomavirus is tropic to the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (mostly by contact-life, less often by sexual means). 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, hyper- or hypothyroidism, menopause), pregnancy, avitaminosis, frequent visits to the solarium, cancer, smoking, and alcohol consumption.
Pathogenesis
The basal layer is thought to contain cells sensitive to papillomavirus and single particles of virus sufficient to stimulate the development of papilloma of the eyelid. HPV is an obligate intracellular parasite, which is usually episomal, b. a. , located in the cytoplasm of the cell. But during reproduction, it can move into the nucleus (integration).
The onset of integration (formation of papilloma of the eyelid) is possible even 20 years after the beginning of infection, the time of development of the disease is determined not only by the virus, but also by the presence of the patient's hereditary predisposition. in combination with other factors. A virus can still produce 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 eyelid papillomas.
The processes of viral replication, assembly of viral particles and their exit from the cell are not fully established. In one cell, the virus can be both in the nucleus and cytoplasm at the same time. When the virus enters the host organism, its cytoplasmic replication begins after entering the cells of the basal layer of the skin. Mature viral particles are actively released from cells in the stratum corneum. These areas of the skin are dangerous due to contact infection.
Symptoms of eye papilloma
The clinical appearance of papilloma of the eyelid depends on the location and characteristics of the growth of knowledge. 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 exophytic formations of gray-yellow color with papillae growing on the surface. In the center there is a vascular loop.
Often they are asymptomatic, the patient consults an ophthalmologist if there is a clear cosmetic defect due to the increase in eye papilloma. When a new tumor appears at the ciliary margin or adjacent to the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and visual impairment. When you blink, the uneven surface of the papilloma of the eyelid is damaged, which leads to the appearance of these symptoms.
Complications
When complications arise, the papilloma is localized on the ciliary edge of the eyelid, in the intermarginal space, in the region of the inner corner of the eye, and the neoplasm spreads to the conjunctiva. It is characterized by the development of chronic lazy conjunctivitis, blepharitis, and corneal opacity. They can cause a violation of the growth of eyelashes, which leads to microtrauma of the cornea with the development of keratitis. Occurrence of ectropion leads to atrophy of the eyeball, erosion and ulceration of the eyeball, visual impairment. In addition, there is always a risk of eyelid papilloma becoming malignant.
Diagnostics
Diagnosing eyelid papilloma begins with an ophthalmologist's examination and visual examination of the patient. Then the doctor uses standard examination methods: visiometry, tonometry, refractometry, computer perimetry, biomicroscopy with a slit lamp. Among the additional methods, if necessary, optical coherence tomography or computer tomography is used (prescribed for several papillomas of different localization), material is taken for biopsy (by scraping, scraping or cutting), and then histological examination is performed. In some cases, a consultation with a dermatologist is necessary.
Treatment of eyelid papilloma
For the treatment of eyelid papilloma, chemical or physical methods of tumor destruction are used. At the same time, antiviral drugs with immunomodulatory action are prescribed. Physical destructive methods include removal of eyelid papilloma using electrocoagulation, laser therapy, and cryotherapy (dissolving the tumor with liquid nitrogen). The chemical method is based on the use of various keratolytic agents. The choice of treatment method depends on the location and distribution of the neoplasm, and the age of the patient. The prognosis is generally favorable.
Prevention
Preventive measures are aimed at reducing the risk of human papillomavirus infection. Mandatory condom use is recommended during casual sex. If symptoms of HPV infection are detected, it is required to examine all sexual partners of the patient and prescribe adequate treatment. To reduce the risk of papilloma of the eyelid, it is necessary to maintain immunity, avoid touching the eyes with dirty hands, lead a healthy lifestyle, avoid excessive work and be active in sports. Refusal to go to the solarium significantly reduces the risk of eyelid papilloma.