eyelid papillomas- tumor-like neoplasms on the skin of the eyelids, due to infection with the human papillomavirus. As a rule, papillomas appear only as a cosmetic defect, in some localizations pain, foreign body sensation and other symptoms are possible. For diagnostics, visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp are used. Of the additional methods, CT and biopsy were used, followed by histology of the material. Treatment of eyelid papilloma - removal of the tumor using chemical or physical methods of destruction. Prescription of antiviral drugs is mandatory.
General information
Papilloma of the eyelid is a tumor of the integumentary epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia, caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignancy is rare. These neoplasias 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, this 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.
Reason
The main etiological factor provoking the development of eyelid papilloma is infection with the human papillomavirus (HPV). There are more than 100 types of papillomavirus. Human papillomavirus is tropic to the epidermis of the skin, is transmitted by direct contact with infected epithelium (most often there is household contact, less often sexual transmission). In addition, it can be transmitted from mother to fetus.
Factors contributing to the development of eyelid papillomas include genetic predisposition, immunological and hormonal disorders (diabetes mellitus, hyper- or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to solariums, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that in the basal layer there are cells that are sensitive to the papillomavirus and that a single particle of the virus is sufficient to stimulate the development of eyelid papillomas. HPV is an obligate intracellular parasite that is usually present in an episomal form, that is, it is located in the cytoplasm of cells. However, during reproduction, it can migrate into the nucleus (integration).
The onset of integration (the formation of papillomas of the eyelids) is possible even after 20 years from the start of infection, the timing of the 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, viruses are capable of producing intact viral particles. At this stage, the infection is often asymptomatic, highly contagious, and can easily spread to other tissues and organs and cause papillomas of the eyelids.
The processes of viral replication, assembly of viral particles and their release from cells have not been fully defined. Within a single cell, the virus can simultaneously exist in the nucleus and cytoplasm. When the virus enters the host organism, cytoplasmic replication begins after penetration into the cells of the basal layer of the skin. In the stratum corneum, there is active release of mature virus particles from cells. These areas of the skin are dangerous due to contact infection.
Symptoms of eyelid papillomas
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 widely. Most often, papillomas are localized in the lower eyelid and do not affect visual acuity. They are characteristic exophytic formations of yellow-gray color with papillary growths on the surface. In the middle is a vascular loop.
Usually asymptomatic, patients turn to an ophthalmologist if an obvious cosmetic defect occurs due to an increase in eyelid papillomas. When a neoplasm appears at the ciliary rim or at the junction with the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and decreased vision. When blinking, the cornea is damaged by the uneven surface of the eyelid papilloma, which causes this symptom.
Complications
Complications arise when the papilloma is localized on the ciliary edge of the eyelid, in the intermarginal space, in the inner corner of the eye, and also when the neoplasm spreads to the conjunctiva. Characterized by chronic sluggish development of conjunctivitis, blepharitis, clouding of the cornea. They can lead to impaired growth of eyelashes, leading to microtrauma of the cornea with the development of keratitis. The formation of ectropion causes erosion and ulcers of the cornea, impaired visual function, to atrophy of the eyeball. In addition, there is always a risk of malignancy of eyelid papillomas.
Diagnostic
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, computerized perimetry, biomicroscopy with a slit lamp. Of the additional methods, if necessary, optical coherence tomography or computed tomography is used (appointed for multiple papillomas of various localizations), material is taken for biopsy (using imprints, scrapings or sections) followed by histological examination. In some cases, 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 neoplasms are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include removal of eyelid papillomas using electrocoagulation, laser therapy, cryotherapy (destruction of neoplasms with liquid nitrogen). The chemical method is based on the use of various keratolytic agents. The choice of treatment options depends on the location and prevalence of the neoplasm, the patient's age. The prognosis is often favorable.
Prevention
Preventive measures are aimed at reducing the risk of human papillomavirus infection. Mandatory use of condoms during casual sex is encouraged. 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, not touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and exercise actively. Refusal to visit the solarium significantly reduces the risk of papillomas of the eyelids.