The Human Papillomavirus (HPV) is a group of common viruses known for causing growths on the skin and mucous membranes. While often associated with other parts of the body, HPV can also cause lesions on the ocular surface, the outer layer of the eye. These growths are relatively uncommon and occur when the virus infects the surface epithelium. HPV is a recognized cause of specific, generally benign, eye conditions that may require medical attention.
Ocular Manifestations of HPV
The most frequent ocular issue from HPV is the conjunctival papilloma, a benign tumor on the conjunctiva, which is the clear membrane covering the white of the eye and lining the eyelids. These growths have a distinct appearance, often described as pinkish, fleshy masses with a raspberry-like or cauliflower-like texture. They can be pedunculated (attached by a stalk) or sessile (having a flatter, broader base). While they can appear anywhere on the conjunctiva, they are often found in the inferior or medial parts of the eye.
Individuals with a conjunctival papilloma may experience several symptoms. A persistent feeling of having something in the eye, known as a foreign body sensation, is common. Other symptoms include redness, irritation, excessive tearing, and light sensitivity. If a lesion grows large enough, it can interfere with the tear flow across the cornea, potentially causing dryness or blood-tinged tears.
Although most conjunctival papillomas are harmless, they can harbor cellular changes. In rare instances, particularly with certain high-risk HPV types, these lesions can be associated with more serious conditions like ocular surface squamous neoplasia (OSSN). This potential progression makes a professional evaluation for any new or changing growth on the eye’s surface important.
Transmission to the Eye
HPV can be transferred to the ocular surface through a few distinct pathways. A primary method is autoinoculation, where the virus is transferred from one part of the body to another. This occurs when an individual with an HPV-induced wart on their hand touches or rubs their eye, inadvertently introducing the virus to the conjunctiva.
Another route is vertical transmission, which occurs during childbirth when an infant passes through the birth canal of a mother with a genital HPV infection. This explains why conjunctival papillomas are sometimes diagnosed in children.
Diagnostic Procedures
Diagnosing an HPV-related eye growth begins with a clinical evaluation by an ophthalmologist. The physician uses a slit lamp, a specialized microscope, to get a magnified view of the growth’s characteristics and location. The appearance of a fleshy, papillomatous mass often suggests an HPV-related cause.
While the appearance is suggestive, a definitive diagnosis requires a biopsy. In an excisional biopsy, the entire lesion is surgically removed and sent for histopathology. A pathologist then examines the tissue for cellular changes characteristic of an HPV infection, such as dysplasia.
To confirm the virus’s presence, molecular techniques like polymerase chain reaction (PCR) are used on the tissue sample to detect HPV DNA. This method can also identify the specific viral subtype. Low-risk types 6 and 11 are most commonly associated with benign conjunctival papillomas, while others are considered high-risk.
Medical and Surgical Interventions
The standard treatment for a conjunctival papilloma is complete surgical excision. The goal is to remove the entire visible lesion down to its base to reduce the chance of it growing back. Surgeons perform the removal while preserving as much healthy surrounding tissue as possible.
Because these lesions can recur, surgeons often use adjunctive therapies during or after the excision. Cryotherapy, which involves freezing the tissue at the lesion’s base, is used to destroy any remaining microscopic viral particles and lower the risk of recurrence.
Topical medications may also be prescribed to reduce the risk of recurrence. Mitomycin C, a topical chemotherapy, can be applied to the eye’s surface to eliminate residual abnormal cells. For persistent cases, injections of immunomodulatory drugs like Interferon may be used to help the immune system fight the virus. The ophthalmologist tailors the treatment combination based on the lesion’s size, location, and history. Follow-up appointments are necessary to monitor for recurrence.