papillomas of the eyelids- tumor-like growths on the skin of the eyelid resulting from human papillomavirus infection. Papillomas, as a rule, appear only as a cosmetic defect, pain, a sensation of a foreign body and other symptoms are possible in some places. For diagnostics, visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp are used. Of the additional methods, CT and biopsy are used, followed by a histology of the material. Treatment of papillomas of the eyelids - removal of the tumor using chemical or physical methods of destruction. Prescribing antiviral drugs is mandatory.
general information
Eyelid papillomas are tumors of the skin epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia caused by the human papillomavirus. Papillomas of the eyelids are mostly benign tumors, malignancy is rare. These neoplasms account for 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 temperate and subarctic climates, the disease is diagnosed less often. The age group of the patients is over 30 years old, the average age of the patients is between 45 and 60 years. Women get sick one and a half times more often than men.
The reasons
The leading etiological factor provoking the development of eyelid papilloma is human papillomavirus (HPV) infection. There are over 100 different types of papillomavirus. Human papillomavirus is tropic to the epidermis of the skin, it is transmitted by direct contact with the infected epithelium (most often there is contact household, less often sexual transmission). Also, it can be transmitted from mother to fetus.
Factors contributing to the development of eyelid papilloma include genetic predisposition, immunological and hormonal disorders (diabetes mellitus, hyper- or hypothyroidism, menopause), pregnancy, beriberi, frequent visits to solarium, cancer, smoking, alcohol consumption.
pathogenesis
It is believed that in the basal layer there are cells sensitive to the papillomavirus and enough individual particles of the virus to stimulate the development of the eyelid papilloma. HPV is an obligate intracellular parasite that is normally present in the episomal form, i. H. located in the cytoplasm of the cell. During reproduction, however, it can migrate into the cell nucleus (integration).
The onset of integration (the formation of papillomas of the eyelids) is possible even after 20 years from the onset of infection, the timing of the 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. The virus is also able to produce intact virus particles in the cytoplasm. At this stage, the infection is often asymptomatic, highly contagious and can easily spread to other tissues and organs, causing eyelid papillomas.
The processes of virus replication, assembly of viral particles and their release from the cell are not yet fully understood. 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 penetration into the cells of the basal layer of the skin. In the stratum corneum there is an active release of mature virus particles from cells. These skin areas are dangerous in terms of contact infection.
Eyelid Papilloma Symptoms
The clinical picture of eyelid papilloma depends on the location and features of the growth of education. Size, color, shape and growth pattern can vary widely. Most often, papillomas are localized 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 middle is a vascular loop.
Usually they are asymptomatic, the patient turns to an ophthalmologist if there is an obvious cosmetic defect due to an increase in the eyelid papilloma. If a neoplasm occurs at the ciliary edge or at the border with the conjunctiva, the patient may complain of severe pain, foreign body sensation, blepharospasm, hyperemia, and decreased 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 region of the inner corner of the eye, and also when the neoplasm spreads to the conjunctiva. Characterized by the development of chronic sluggish conjunctivitis, blepharitis, corneal opacities. They can cause eyelash growth disorders, which with the development of keratitis lead to microtrauma of the cornea. The formation of ectropion causes the appearance of erosion and ulcers of the cornea, impairment of visual function up to atrophy of the eyeball. In addition, there is always a risk of malignancy of the eyelid papilloma.
diagnosis
Diagnosis of eyelid papilloma begins with an examination and visual examination of the patient by an ophthalmologist. Then the doctor uses standard methods of examination: visiometry, tonometry, refractometry, computerized perimetry, biomicroscopy with a slit lamp. Of the additional methods, if necessary, optical coherence tomography or computed tomography is used (appointed for multiple papillomas of various localizations), material is taken for a biopsy (using an impression, scraping or incision), followed by histological examination. In some cases, consultation with a dermatologist is required.
Treatment of papillomas of the eyelids
To treat papillomas of the eyelids, chemical or physical methods of destroying the neoplasm are used. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physically destructive methods include removal of the eyelid papilloma by 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 localization and prevalence of the neoplasm and 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 and the appointment of appropriate treatment are required. To reduce the risk of developing eyelid papillomas, it is necessary to take measures to maintain immunity, not to touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and actively play sports. Refusal to visit the solarium significantly reduces the risk of developing papilloma of the eyelids.