Eyelid papillomas- tumor-like tumors in the skin of the eyelid, caused by human papilloma virus infection. Most often, papillomas appear only as a cosmetic defect, in some localizations, pain, foreign body sensation, and other symptoms are possible. Visiometry, tonometry, refractometry, computer perimetry, slit-lamp biomicroscopy are used for diagnostics. Additional methods include CT and biopsy, followed by histology of the material. Treatment of papilloma of the eyelids - removal of the tumor using chemical or physical methods of destruction. A prescription for antiviral drugs is mandatory.
general information
Papillomas of the eyelids are epithelial tumors of the accessory eye apparatus with varying degrees of dysplasia caused by the human papillomavirus. Most often, eyelid papillomas are benign tumors, malignant tumors are rare. These neoplasms account for 60-65% of all eyelid neoplasms. Most often (3. 5 cases per 100, 000 inhabitants) this pathology occurs in people living in equatorial countries. In Australia, the prevalence is 1. 9 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, the average age of patients varies from 45 to 60 years. Women are affected one and a half times more often than men.
Reasons
The main etiological factor provoking the development of eyelid papilloma is human papillomavirus (HPV) infection. There are more than 100 different types of papillomaviruses. The human papillomavirus is tropic in the epidermis of the skin, transmitted by direct contact with infected epithelium (usually contact-domestic, less often sexually). In addition, it can be transmitted from mother to fetus.
Factors promoting the development of eyelid papilloma are genetic predisposition, immunological and hormonal disorders (diabetes, hyper- or hypothyroidism, menopause), pregnancy, vitamin deficiency, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
The basal layer is thought to contain papillomavirus-susceptible cells and enough single virus particles to promote the development of eyelid papillomas. HPV is an obligate intracellular parasite that usually exists in an episomal form, i. e. i. e. , is in the cytoplasm of the cell. However, it can migrate into the nucleus during reproduction (integration).
The beginning of integration (formation of eyelid papilloma) is possible even 20 years after infection, the time of disease development is determined not only by the virus, but also by the patient's hereditary predisposition. along with other factors. Even when in the cytoplasm, the virus can produce intact virus particles. At this stage, the infection is often asymptomatic, highly contagious, can easily spread to other tissues and organs, and cause eyelid papillomas.
The processes of virus replication, assembly of virus particles and their release from the cell have not been fully determined. In one cell, the virus can simultaneously exist in both the nucleus and the cytoplasm. When the virus enters the host's body, having penetrated the cells of the basal layer of the skin, its cytoplasmic replication begins. Mature virus particles are actively released from cells in the stratum corneum. These skin areas are dangerous for contact infection.
Symptoms of eyelid papilloma
The clinical picture of papilloma of the eyelids 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 on the lower eyelid and do not affect visual acuity. They are characteristic grayish-yellow exophytic formations with papillary growths on the surface. In the center is a vascular loop.
Most of the time, they are asymptomatic, the patient consults an ophthalmologist if an obvious cosmetic defect occurs due to an increase in eyelid papilloma. When a neoplasm appears on the ciliary edge or at the border of the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and decreased vision. Blinking damages the cornea on the uneven surface of the eyelid papilloma, which is why these symptoms appear.
Complications
Complications arise when the papilloma is localized on 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. Development of chronic indolent conjunctivitis, blepharitis, corneal opacity is characteristic. They can cause eyelash growth disorders, resulting in corneal microtrauma and the development of keratitis. The formation of ectropion causes the appearance of corneal erosion and ulcers, impaired visual function up to atrophy of the eyeball. In addition, there is always a risk of eyelid papilloma malignancy.
Diagnostics
The diagnosis of papilloma of the eyelids begins with a patient survey and a visual examination by an ophthalmologist. Then the doctor applies standard research methods: visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp. From the additional methods, optical coherence tomography or computer tomography is used if necessary (prescribed for multiple papillomas of various localization), material is taken for biopsy (using an impression, scratch or cut), followed by a histological examination. In some cases, a consultation with a dermatologist is necessary.
Treatment of eyelid papillomas
Chemical or physical methods of destroying the neoplasm are used to treat papilloma of the eyelids. At the same time, antiviral drugs with immunomodulating 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 treatment method depends on the location and spread of the neoplasm, the age of the patient. The prognosis is often favorable.
Prevention
Preventive measures aim to reduce the risk of human papilloma virus infection. It is recommended to use condoms during casual intercourse. After detecting signs of HPV infection, it is necessary to examine all the patient's sexual partners and prescribe appropriate treatment. In order to reduce the risk of developing eyelid papillomas, it is necessary to take measures to maintain immunity, avoid touching the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and do active sports. Refusal to visit the solarium significantly reduces the risk of eyelid papilloma.