Human Papillomavirus (HPV) is a widespread viral infection. While often associated with other body areas, specific HPV types can affect the eyes. Ocular HPV manifestations are relatively uncommon, but understanding them is important for eye health.
How HPV Affects the Eyes
HPV can manifest in the eyes through two conditions: conjunctival papillomas and ocular surface squamous neoplasia (OSSN). Conjunctival papillomas are benign, wart-like growths on the conjunctiva, the clear membrane covering the white part of the eye and lining the eyelids. These growths often appear fleshy, cauliflower-like, or flat. They are associated with low-risk HPV types, such as HPV-6 and HPV-11.
Conjunctival papillomas are non-cancerous but can recur after treatment. In contrast, Ocular Surface Squamous Neoplasia (OSSN) includes precancerous and cancerous lesions affecting the eye’s surface, including the conjunctiva and cornea. OSSN is linked to high-risk HPV types, particularly HPV-16 and HPV-18. These lesions may appear as fleshy, gelatinous, or white-gray patches, sometimes with visible feeder vessels.
Symptoms and Diagnosis
Symptoms of HPV in the eyes vary and are often non-specific, depending on the lesion’s size and location. Common complaints include irritation, a foreign body sensation, redness, and excessive tearing. If the growth is large or affects the cornea, it can lead to blurred or fluctuating vision.
Many cases, especially in early stages, might not cause noticeable symptoms. Diagnosis typically involves a comprehensive eye examination by an ophthalmologist using a slit lamp. A definitive diagnosis, particularly for OSSN, often requires a biopsy. This sample is examined to differentiate the condition and detect HPV DNA, often through techniques like immunohistochemistry or PCR testing.
Treatment Approaches
Treatment for ocular HPV depends on the condition, lesion size and location, and whether it is benign or malignant. Surgical excision is a primary treatment for both papillomas and OSSN. This procedure often involves wide removal, sometimes with cryotherapy applied to the margins to reduce recurrence risk.
Medical therapies can also be used, either with surgery or as a primary treatment for diffuse or recurrent OSSN, or when surgery is not suitable. These may include topical chemotherapy agents like 5-fluorouracil or interferon alpha-2b. Small, asymptomatic papillomas might be observed, but removal is generally advised due to their potential for growth or malignant transformation. Recurrence is possible, especially with papillomas, requiring long-term follow-up for new lesions.
Transmission and Prevention
HPV can be transmitted to the eyes through direct contact with infected skin or mucous membranes. This often occurs via hand-to-eye contact after touching an HPV-infected area, such as genital, oral, or cutaneous warts. It is not typically spread through casual contact.
Preventive measures for ocular HPV align with general HPV prevention strategies. Practicing good hand hygiene, such as frequent washing, and avoiding touching the eyes with unwashed hands are important. The HPV vaccine, such as Gardasil-9, offers protection against high-risk HPV types that cause most cancers and some low-risk types responsible for warts. By reducing overall HPV prevalence, vaccination indirectly lowers the risk of ocular manifestations.