Eyelid papillae- tumor-like neoplasms on the skin of the eyelid, resulting from infection with the human papillomavirus. Usually, papillomas appear only as a cosmetic defect; in some localizations, pain, foreign body sensation and other symptoms are possible. For diagnostics, optometry, tonometry, refractometry, electronic perimetry, slit-lamp biomicroscopy are used. Of the additional methods, computed tomography and biopsy are used, followed by histology of the material. Treatment of papilloma of the eyelids - removal of the tumor using chemical or physical methods of destruction. Prescription of antiviral drugs is mandatory.
General information
Papillomas of the eyelids are tumors of the epithelial lining of the attachment apparatus of the eye with varying degrees of dysplasia, caused by the human papillomavirus. Most often, eyelid papillomas are benign tumors, malignancy is rare. These neoplasms make up 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, the disease is diagnosed less often. The age group of patients is over 30 years old, the average age of patients ranges from 45-60 years. Women get sick one and a half times more often than men.
The reasons
The main causative factor that causes the development of eyelid papilloma is infection with the human papilloma virus (HPV). There are over 100 different types of papillomaviruses. The human papilloma virus is tropical in the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (more often there is contact-household transmission, less often sexual transmission). In addition, it can be transmitted from the mother to the fetus.
Factors that contribute to the development of eyelid papilloma include genetic predisposition, immune and hormonal disorders (diabetes, hyper- or hypothyroidism, menopause), pregnancy, beri-beri, frequent visits to the solarium, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that in the basal layer there are cells susceptible to the papillomavirus and enough individual virus particles to stimulate papilloma growth. HPV is an obligate intracellular parasite that usually exists in the episomal form, i. e. it resides in the cytoplasm of the cell. However, during reproduction, it can migrate to the core (integration).
The onset of incorporation (the formation of papilloma 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 patient's hereditary predisposition in combination withother factors. Even when in the cytoplasm, the virus is able to produce intact viral particles. At this stage, the infection is often asymptomatic, highly contagious and can easily spread to other tissues and organs and cause eyelid papillomas.
The processes of virus replication, assembly of viral particles and their release from the cell have not been fully documented. In a cell, the virus can exist simultaneously in both the nucleus and the cytoplasm. When the virus enters the host organism, its cytoplasmic replication begins after penetrating the cells of the basal layer of the skin. In the stratum corneum, there is an active release of mature viral particles from the cells. These areas of the skin are at risk for contact infection.
Symptoms of eyelid papilloma
The clinical picture of the papilloma of the eyelids depends on the location and characteristics of the development of the education. Size, color, shape and growth pattern can vary greatly. Most often, papillomas are located on the lower eyelid and do not affect visual acuity. They are characteristic exophytic formations of gray-yellow color with papillary growths on the surface. In the center there is a vascular loop.
They are usually asymptomatic, the patient is referred to an ophthalmologist if an obvious aesthetic defect occurs due to an increase in the ciliary papilloma. When a neoplasm appears at the end of the eyelashes or at 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 abnormal surface of the eyelid papilla, which leads to the appearance of these symptoms.
Complications
Complications arise when the papilloma is located on the ciliary rim of the eyelids, in the interperipheral 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 opacity. They can cause disorders in the development of eyelashes, which leads to microtrauma of the cornea with the development of keratitis. The formation of ectropion causes the appearance of erosion and ulceration of the cornea, impaired visual function, even atrophy of the eyeball. In addition, there is always a risk of eyelid papilloma malignancy.
Diagnostics
The diagnosis of eyelid papilloma begins with a survey and visual examination of the patient by an ophthalmologist. The doctor then uses standard examination methods: vision, tonometry, refractometry, electronic perimetry, slit-lamp biomicroscopy. Of the additional methods, if necessary, optical coherence tomography or computed tomography (intended for multiple papillomas of various localizations) is used, material is taken for biopsy (using imprint, scraping or section) followed by histological examination. In some cases a consultation with a dermatologist is necessary.
Treatment of papillomas of the eyelids
For the treatment of eyelid papilloma, chemical or physical methods of destroying the neoplasm are used. At the same time, antiviral drugs with an immunomodulatory effect are prescribed. Natural destructive methods include removal of the papilloma of the eyelids 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 therapeutic 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 human papillomavirus. The mandatory use of condoms during casual sex is recommended. If signs of HPV infection are detected, it is necessary to examine all the sexual partners of the patient and appoint appropriate treatment. To reduce the risk of eyelid papilloma formation, it is necessary to take measures to maintain immunity, not touch the eyes with dirty hands, lead a healthy lifestyle, avoid excessive work and play active sports. Refusal to visit the solarium significantly reduces the risk of eyelid papillosis.