Papillomas of the eyelids

symptoms of eyelid papilloma

Papillomas of the eyelids- tumor-like neoplasms on the skin of the eyelid, as a result of infection with the human papilloma virus. Usually, papillomas appear only as a cosmetic defect, in some localizations, pain, feeling of a foreign body and other symptoms are possible. Visiometry, tonometry, refractometry, computer perimetry, slit-lamp biomicroscopy are used for diagnosis. Of the additional methods, CT 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.

Main information

Papillomas of the eyelids are tumors of the covering epithelium of the adnexal apparatus of the eye with varying degrees of dysplasia, caused by the human papillomavirus. Most often, papillomas of the eyelids are benign tumors, malignant tumors are rare. These neoplasias account for 60-65% of all eyelid neoplasms. Most often (3. 5 cases per 100, 000 of the 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 category of patients is over 30 years, the average age of patients is 45-60 years. Women get sick one and a half times more often than men.

The reasons

The leading etiological factor provoking the development of papilloma of the eyelids is infection with the human papilloma virus (HPV). There are over 100 different types of papillomavirus. The human papillomavirus is trodden to the epidermis of the skin, transmitted by direct contact with the infected epithelium (most often there is contact-household transmission, less often by sexual means). It can also be passed 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 the solarium, cancer, smoking, alcohol consumption.

Pathogenesis

It is believed that in the basal layer there are cells sensitive to papillomavirus and enough single particles of the virus to stimulate the development of papilloma of the eyelid. 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 playback, it can migrate into the kernel (integration).

The beginning of integration (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 a 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 eyelid papillomas.

The processes of virus replication, assembly of viral particles and their release from the cell are not fully established. In a cell, the virus can exist both in the nucleus and in the cytoplasm. When the virus enters the host's body, 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 virus particles from the cells. These areas of the skin are dangerous in terms of contact infection.

Symptoms of papilloma of the eyelids

The clinical picture of the papilloma of the eyelids 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 located on the lower eyelid and do not affect visual acuity. They are characteristic exophytic formations with a grayish-yellow color with papillary growths on the surface. In the center there 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 the papilloma of the eyelid. When a neoplasm appears on the ciliary edge or on 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 occur when the papilloma is localized in 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 slow conjunctivitis, blepharitis, corneal opacity. They can cause eyelash growth disorders, which leads to corneal microtraumas with the development of keratitis. The formation of ectropion causes the appearance of erosion and ulcers of the cornea, impaired visual function, up to atrophy of the eyeball. In addition, there is always a risk of malignancy of papilloma of the eyelid.

Diagnosis

The diagnosis of papilloma of the eyelids begins with a study and visual examination of the patient by an ophthalmologist. Then the doctor uses standard research methods: visiometry, tonometry, refractometry, computer perimetry, biomicroscopy with a slit lamp. Of the additional methods, if necessary, optical coherence tomography or computer tomography is used (prescribed for multiple papillomas of different localizations), biopsy material is taken (using an impression, scraping or cutting), followed by histological examination. In some cases, a consultation with a dermatologist is necessary.

Treatment of eyelid papillomas

For the treatment of papilloma of the eyelids, chemical or physical methods are used to destroy the neoplasm. At the same time, antiviral drugs with immunomodulatory activity are prescribed. Physical destructive methods include removal of the papilloma of the eyelid 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 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 infection with human papillomavirus. Mandatory use of condoms during casual sex is recommended. When signs of HPV infection are detected, it is necessary to examine all the patient's sexual partners and prescribe adequate treatment. To reduce the risk of eyelid papillomas, it is necessary to take measures to maintain immunity, not touch the eyes with dirty hands, lead a healthy lifestyle, avoid overwork and do active sports. Refusal to visit the solarium significantly reduces the risk of papilloma of the eyelids.