What Is the Conjunctival Papilloma of the Eye?
Conjunctival squamous papilloma is a slowly progressing tumor of the conjunctival epithelium. It affects adults and children and is strongly associated with human papillomavirus (HPV).
What Is the Main Cause of Conjunctival Papilloma?
Human papillomavirus is majorly associated with conjunctival papilloma. HPV is a double-stranded virus belonging to the papilloma family, having high cancer-causing potential. HPV type 6 and type 11 are primarily linked to the conjunctival papilloma of the eye.
How Does Humanpapillomavirus Spread in Conjunctival Papilloma?
The different modes of HPV transfer include:
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HPV is transmitted mainly from mother to child through the placental pathway.
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Adults directly acquire the virus from another infected person from infected individuals and contaminated objects.
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Limbal papillomas are linked to ultraviolet radiation.
What Is the Epidemiological Incidence of Conjunctival Papilloma in Humans?
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Conjunctival papilloma is more common in males than females.
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Both children and younger adults are prone to contracting the HPV infection.
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Limbal papillomas are more common in older people. Squamous papillomas affect the younger age group.
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HPV-associated papillomas also show a family association between twins and siblings.
How Are the Conjunctival Papillomas Grouped?
Based on the age of the patient, tissue structure, and site of the active region after biopsy, conjunctival papillomas are of three types:
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Squamous or infective or the viral conjunctival papilloma.
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Limbal papilloma.
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Inverted papilloma.
All three forms of papillomas differ in their growth pattern. Some tumors originate outward, while some grow inwardly from the conjunctival surface.
What Are the Clinical Signs and Symptoms Associated With Conjunctival Papilloma of the Eye?
People suffering from papilloma of the conjunctiva show myriad signs and symptoms.
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Conjunctival squamous papilloma is most common in the caruncle region with unilateral or bilateral eye involvement.
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Small lesions are mainly without any symptoms. Large lesions are responsible for the following signs and symptoms:
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Dry eyes.
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Incomplete eye closure.
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Epiphora (excessive production of tears).
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Bleeding from the nose (epistaxis).
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Single lesions are common in adults, whereas multiple lesions that merge to form a large lesion are seen in children.
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Limbal lesions primarily affect only one eye. They have the potential to grow slowly in size and lead to impaired vision.
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Inverted papillomas are slow-growing and are primarily unilateral.
How Does a Conjunctival Papilloma Look Clinically?
The conjunctival papilloma tissue is examined physically. On physical examination with the slit-lamp technique, the following features are observed:
The Lesion Site:
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Squamous papillomas are more common between the eyelids (interpalpebral).
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Limbal tumors are present in the bulbar region of the conjunctiva.
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Inverted papilloma is more common in the nasal, paranasal, and tear gland (lacrimal) regions.
The Texture of the Lesion:
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Tumors of the conjunctival papilloma have a cobblestone appearance.
The Growth Pattern of the Tumor:
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Conjunctival papilloma has a solitary growth pattern.
The Consistency of the Tumor:
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Papillomas are mobile over the sclera.
What Are the Methods Used to Diagnose Conjunctival Papilloma of the Eye?
Diagnosis of papilloma involves:
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Proper and complete history taking.
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Physical evaluation of the patient.
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A few confirmatory tests.
History Taking: Patients should be asked about their past medical history, previous tumor, immune condition, ultraviolet exposure, and vaccination status.
Physical Evaluation: Patients are examined thoroughly to determine the gross features and signs of the tumor using the slit-lamp technique. In the slit lamp technique, a narrow, intense light is passed through the microscope to view the ocular structures.
Confirmatory Tests: Biopsy, impression cytology, optical coherence tomography (OCT), and ultrasound biomicroscopy are a few confirmatory tests performed to aid the process of forming an accurate diagnosis.
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A biopsy is conducted by removing a part or complete lesion under anesthesia.
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Impression cytology involves the collection of surface tissue with the help of filter paper.
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OCT does cross-sectional imaging of the eye to illustrate the thickened epithelium.
What Are the Factors That Play a Key Role in Choosing the Mode of Treatment for Conjunctival Papilloma?
The mode of treatment most relevant for a patient is determined are -
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Patients age.
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Location and extent of the lesion.
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Systemic conditions.
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The aggressiveness of the tumor.
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Response to nonsurgical management.
How Is Conjunctival Papilloma of the Eye Managed?
The different approaches employed for treating papilloma are:
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Small lesions do not require any treatment; follow-up is enough.
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Moderate lesions are managed with the help of a nonsurgical approach.
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Extensive lesions are managed surgically.
Nonsurgical Management of Conjunctival Papilloma Includes:
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Interferon alpha is administered topically or systemically. They have a direct effect on tumors and improve immunity.
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Mitomycin C is given topically as an adjunct to excision. It reduced the rate of recurrence.
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Oral Cimetidine is a safe alternative in pediatric patients with papilloma. They improve the immune response in patients when given in high doses.
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Dinitrochlorobenzene, an important industrial chemical, is administered topically when other treatment modalities fail. It stimulates a delayed immune response in the patient's body.
All conservative management strategies are employed to reduce the pitfalls linked to surgical procedures.
Surgical Treatment of Very Large Lesions Comprises:
- Surgical treatment of aggressive papilloma often spreads and increases the disease's recurrence rate.
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Cryotherapy is indicated for squamous papillomas. They reduce the recurrence rates.
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Carbon dioxide lasers and photocoagulation therapy are applied directly over the tumor site. They have tumor-killing properties.
What Are the Few Diseases That Mimic Conjunctival Papilloma of the Eye?
A few diseases that mimic conjunctival papilloma include:
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Ichthyosis (white or gray scales with dryness noted on the skin).
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Conjunctival squamous cell malignant tumor is the carcinoma of the conjunctiva.
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Sebaceous gland carcinoma is a metastatic tumor of oil-secreting glands.
What Is the Overall Outlook of Conjunctival Papilloma of the Eye?
Conjunctival papilloma has a good prognosis but has a high recurrence rate. Recurrent lesions are more aggressive and are more common after surgical treatment of the initial lesion. Patients with conjunctival papilloma should be under regular follow-up for at least one year.
Conclusion:
Conjunctival papilloma is a benign condition of the eye with a high recurrence rate. Appropriate treatment protocol and long-term follow-up help resolve the state with diminished recurrence.
