Papillomas of the eyelids- tumor neoplasms on the skin of the eyelids, which are the result of infection with the human papilloma virus. Usually, papillomas appear only as a cosmetic defect, and 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. Additional methods include CT and biopsy, followed by material histology. Treatment of papilloma of the eyelids - removal of the tumor by chemical or physical methods of destruction. Prescription of antiviral drugs is mandatory.
General information
Papillomas of the eyelids are tumors of the integumentary epithelium of the adnexal apparatus of the eye with various degrees of dysplasia, caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignant ones are rare. These neoplasias 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 cases per 100, 000 inhabitants. 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 ranges from 45-60 years. Women get sick one and a half times more often than men.
Reasons
The leading etiological factor that causes the development of papillomas of the eyelids is infection with the human papillomavirus (HPV). There are over 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 it is contact-household, less often sexual). In addition, it can be transmitted from mother to fetus.
Factors that contribute to the appearance of eyelid papillomas are genetic predisposition, immunological and hormonal disorders (diabetes mellitus, hyper- or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that the basal layer contains cells sensitive to the papillomavirus and enough individual virus particles to stimulate the development of eyelid papillomas. HPV is an obligate intracellular parasite that is usually present in an episomal form, i. e. located in the cytoplasm of the cell. However, during reproduction it can migrate into the nucleus (integration).
The beginning of integration (formation of papillomas of the eyelids) is possible even after 20 years from the beginning of the 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 is able to produce intact virus 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 virus multiplication, assembly of viral particles and their release from the cell have not been fully determined. In one cell, the virus can exist simultaneously in the nucleus and in the cytoplasm. When the virus enters the host's organism, its cytoplasmic replication begins after penetrating the cells of the basal layer of the skin. In the stratum corneum, mature virus particles are actively released from the cells. These areas of the skin are dangerous in terms of contact infection.
Symptoms of eyelid papilloma
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 greatly. Most often, papillomas are localized on the lower eyelid and do not affect visual acuity. These are characteristic grayish-yellow exophytic formations with papillary growths on the surface. In the middle is a vascular loop.
They are usually asymptomatic, the patient consults an ophthalmologist if there is an obvious cosmetic defect due to an increase in papillomas of the eyelids. When the neoplasm appears on the edge of the ciliary or on the border with the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia and reduced vision. When blinking, the cornea is damaged by the uneven surface of the papilloma of the eyelid, which leads to the appearance of these symptoms.
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. It is characterized by the development of chronic sluggish conjunctivitis, blepharitis, corneal clouding. They can cause eyelash growth disorders, which leads to corneal microtrauma with the development of keratitis. The formation of ectropion causes erosion and ulcers of the cornea, impairment of visual function, up to atrophy of the eyeball. In addition, there is always a risk of eyelid papilloma malignancy.
Diagnostics
The diagnosis of eyelid papilloma begins with an examination 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 computer tomography (appointed for multiple papillomas of different localization) is used, biopsy material is taken (using an impression, scraping or cut), followed by a histological examination. In some cases, a consultation with a dermatologist is necessary.
Treatment of eyelid papilloma
For the treatment of papilloma of the eyelids, chemical or physical methods of destroying the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include the removal of eyelid papillomas using 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 often favorable.
Prevention
Preventive measures are aimed at reducing the risk of infection with the human papillomavirus. Mandatory use of condoms during casual sex is recommended. If signs of HPV infection are detected, an examination of all the patient's sexual partners is required and the appointment of adequate treatment. To reduce the risk of developing papillomas on the eyelids, it is necessary to take measures to maintain immunity, not touch the eyes with dirty hands, lead a healthy lifestyle, avoid excessive work and actively engage in sports. Refusal to visit the solarium significantly reduces the risk of papillomas of the eyelids.