Papillomas in the eyelids- a tumor-like tumor on the skin of the eyelid, caused by infection with the human papillomavirus. Usually, papillomas appear only as a cosmetic defect; in some locations, pain, foreign body sensation and other symptoms are possible. Optical measurements, tonometry, refraction measurements, computer-controlled peripheral measurements, biomicroscopic analyzes with a slit lamp are used for diagnosis. Of the additional methods, CT and biopsy are used, followed by histology of the material. Treatment of eyelid papilloma - removal of the tumor by chemical or physical methods of destruction. Prescription of antiviral drugs is mandatory.
general information
Eyelid papillomas are tumors of the epithelium of the eye with varying degrees of dysplasia caused by the human papillomavirus. Most often, papillomas in the eyelids are benign tumors, malignancy is rare. These tumors account for 60–65% of all eyelid tumors. 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 older than 30 years, the average age of patients is between 45-60 years. Women get sick one and a half times more often than men.
The reasons
The main causative factor causing the development of eyelid papillomas is infection with the human papillomavirus (HPV). There are over 100 different types of papillomavirus. The human papillomavirus is tropical in the epidermis of the skin, it is transmitted by direct contact with infected epithelial tissue (most often it is contact with a household, less often sexual transmission). In addition, it can be transmitted from mother to fetus.
Factors that contribute to the development of eyelid papillomas include genetic predisposition, immune and hormonal disorders (diabetes, hypothyroidism, menopause), pregnancy, beriberi, frequent visits to tanning beds, cancer, smoking, alcohol consumption.
Pathogenesis
It is believed that the basal layer contains cells that are sensitive to the papillomavirus and enough single particles of the virus to stimulate the development of eyelid papillomas. HPV is an obligate intracellular parasite that is usually present in an episomal form, i. e. e. located in the cytoplasm of the cell. However, during reproduction, it can migrate into the nucleus (integration).
The beginning of integration (formation of papilloma in the eyelids) is possible even after 20 years from the beginning of the infection, the time of the disease is determined not only by the virus, but also by the presence of hereditary predisposition of the patient. mixed with other factors. Even while in the cytoplasm, the virus can produce intact virus particles. At this stage, the infection is often asymptomatic, highly contagious and can easily spread to other tissues and organs, causing eyelid papillomas.
The process of viral replication, assembly of viral particles and their release from the cell has not been fully established. In one cell, the virus can be simultaneously both in the nucleus and in the cytoplasm. When the virus enters the host organism, its cytoplasmic replication begins after it has entered the cells of the basal layer of the skin. In the stratum corneum there is an active release of mature viral particles from cells. These areas of the skin are dangerous in relation to contact infection.
Symptoms of papilloma in the eyelids
The clinical picture of eyelid papilloma 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. These are characteristic depositional formations with a gray-yellow color with papillary growths on the surface. In the middle is a vascular loop.
Usually they are asymptomatic, the patient turns to an ophthalmologist if an obvious cosmetic defect occurs due to an increase in eyelid papilloma. When a tumor occurs at the edge of the thoracic cavity or at the border of the conjunctiva, the patient may complain of severe pain, sensation of foreign bodies, hematoma, anemia, and impaired vision. When blinking, the cornea is damaged due to 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 edge of the eyelids, in the intermarginal space, in the area of the inner corner of the eye, and also when the tumor spreads to the conjunctiva. Characterized by the development of chronic progressive conjunctivitis, uveitis, corneal opacity. They can cause eyelash growth disorders, leading to microbial damage to the cornea with the development of keratitis. The formation of ectropion causes erosion and ulceration of the cornea, reduced visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy in eyelid papilloma.
Analysis
Diagnosis of papilloma in the eyelids begins with a survey and visual examination of the patient by an ophthalmologist. The doctor then uses standard examination methods: optical measurements, tonometry, refraction measurements, computer-controlled peripheral measurements, biomicroscopy analyzes with a slit lamp. Of additional methods, if necessary, optical coherence tomography or computer tomography is used (ordered for multiple papillomas of various locations), material is taken for biopsy (by imprinting, scraping or cutting) followed by histological examination. In some cases, it is necessary to consult a dermatologist.
Treatment of eyelid papillomas
To treat papillomas in the eyelids, chemical or physical methods of tumor destruction are used. At the same time, antiviral drugs with immunosuppressive activity are prescribed. Physical destruction methods include removal of eyelid papilloma with electrocoagulation, laser therapy, cryotherapy (destruction of the tumor with liquid nitrogen). The chemical method is based on the use of various keratolytic agents. The choice of treatment depends on the location and prevalence of the tumor, the age of the patient. The outlook is often favorable.
Prevention
Preventive measures aim to reduce the risk of human papillomavirus infection. The mandatory use of condoms during casual sex is recommended. If signs of HPV infection are detected, all the patient's sexual partners must be examined and adequate treatment prescribed. To reduce the risk of developing eyelid papillomas, it is necessary to take measures to maintain immunity, do not touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and actively play sports. Refusal to visit the tanning bed significantly reduces the risk of eyelid papilloma.