Papillomas of the eyelids- Tumor-like neoplasms on the eyelid skin, as a result of human papillomavirus infection. Usually, papillomas appear only as a cosmetic defect, in some locations, pain, foreign body sensation and other symptoms are possible. Visometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit are used for diagnosis. Additional methods include CT and biopsy, followed by histology of the material. Treatment of eyelid papilloma - tumor removal using chemical or physical methods of destruction. Antiviral drugs must be prescribed.
General Information
Papillomas of the eyelids are tumors of the entire epithelium of the adnexal apparatus of the eye with various degrees of dysplasia, caused by the human papillomavirus. Most often, eyelid papillomas are benign tumors, malignant tumors are rare. This neoplasm accounts 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 cases per 100, 000 population. In countries with a temperate and subarctic climate, the disease is diagnosed less often. The age category of patients is more than 30 years, the average age of patients ranges from 45-60 years. Women get sick one and a half times more often than men.
Reasons
The leading etiological factor that causes eyelid papilloma is infection with human papillomavirus (HPV). There are more than 100 types of papillomavirus. Human papillomavirus is tropic for the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (most often it is contact household, less often sexual transmission). In addition, it can be transmitted from mother to fetus.
Factors contributing to the development of eyelid papilloma are: genetic predisposition, immunological and hormonal disorders (diabetes, hyper- 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 papillomavirus and enough individual particles of the virus to stimulate the development of papilloma of the eyelids. HPV is an obligate intracellular parasite that is usually found in an episomal form, that is, located in the cytoplasm of the cell. However, during reproduction it can migrate into the nucleus (integration).
The onset of integration (formation of papilloma of the eyelids) is possible even 20 years after the beginning of the infection, the time of the development of the disease is determined not only by the virus, but also by the presence of the patient's hereditary predisposition. along with other factors. Even while in the cytoplasm, the virus can form intact viral particles. At this stage, the infection is often asymptomatic, highly contagious and easily spreads to other tissues and organs, causing eyelid papillomas.
The processes of virus replication, assembly of viral particles and their release from the cell have not been fully established. In one cell, the virus can exist both in the nucleus and in the cytoplasm. When the virus enters the host body, its cytoplasmic replication begins after penetrating the cells of the basal layer of the skin. In the stratum corneum, mature viral particles are actively released from the cells. These skin areas are dangerous for contact infection.
Symptoms of eyelid papilloma
The clinical picture of papilloma of the eyelid depends on the location and characteristics of the growth of 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 characterized by grayish-yellow exophytic formations with papillary growths on the surface. In the center is a vascular loop.
As a rule, they are asymptomatic, the patient consults an ophthalmologist if an obvious cosmetic defect appears due to the increase of eyelid papilloma. When a neoplasm appears on the edge of the eyelashes or on the border of the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia and decreased vision. When you blink, the cornea is damaged by the uneven surface of the eyelid papilloma, which causes these symptoms.
Complications
Complications arise when the papilloma is localized on the ciliary edge of the eyelids, in the marginal space, in the area of the inner corner of the eye, and also when the neoplasm spreads to the conjunctiva. It is characterized by the development of chronic sluggish conjunctivitis, blepharitis, corneal transparency. They can cause a violation of eyelash growth, which leads to microtrauma of the cornea with the development of keratitis. The formation of ectropion leads to the formation of corneal erosion and ulcers, a decrease in visual function, to atrophy of the eyeball. In addition, there is always a risk of malignant development of eyelid papilloma.
diagnosis
The diagnosis of eyelid papilloma begins with an ophthalmologist's examination of the patient and visual examination. Then the doctor uses standard examination methods: visometry, tonometry, refractometry, computerized perimetry, biomicroscopy with slit. From the additional methods, if necessary, optical coherence tomography or computer tomography is used (indicated for multiple papillomas of different localization), material is taken for biopsy (using an impression, scraping or cutting), followed by histological examination. In some cases, it is necessary to consult a dermatologist.
Treatment of eyelid papillomas
For the treatment of eyelid papilloma, chemical or physical methods of neoplasm destruction are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include eyelid papilloma removal using electrocoagulation, laser therapy, cryotherapy (neoplasm destruction 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 spread of the neoplasm, the age of the patient. 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 recommended. If signs of HPV infection are detected, it is necessary to examine all sexual partners of the patient and prescribe adequate treatment. To reduce the risk of papillomas of the eyelids, it is necessary to take measures to maintain immunity, do not touch the eyes with dirty hands, lead a healthy lifestyle, avoid excessive work and actively play sports. Avoiding the solarium significantly reduces the risk of eyelid papillomas.