Approach Considerations
When addressing eyelid papilloma, the treatment approach hinges on both the presentation and severity of the lesion. Benign papillomas that remain asymptomatic and don't pose significant cosmetic concerns often can be observed without immediate intervention. However, if there's any uncertainty in the clinical diagnosis, early incisional or excisional biopsies are recommended to guide the treatment course. For symptomatic papillomas, safe and straightforward in office excision is standard approach. During these procedures, it's imperative to exercise caution to protect vital ocular and adnexal structures, such as the canthal tendons, lacrimal puncta and canaliculi, lacrimal sac, and the ocular surface. Ensuring their preservation is crucial to prevent postoperative complications and maintain optimal eye function. Complete excision of papilloma is preferred to prevent recurrence and offer the best therapeutic outcome.
Medical Care
Lee et al studied eyelid margin papillomas for which complete excision was cosmetically unacceptable. The study reported a case in which interferon was an effective treatment for a conjunctival papilloma. [11]
Surgical Care
The surgical management of benign eyelid tumors is tailored to ensure not only the complete removal of the lesion but also the preservation of the eyelid's functional and aesthetic integrity. Papilloma excision technique is as follows:
- Preparation: Administer a topical tetracaine drop in the affected eye to prevent irritation from the cleaning agent. Clean the area of the papilloma and the adjacent eyelid tissue using a full-strength povidone-iodine solution. Use a small sterile drape, ideally with a hole cut out, to isolate the lesion.
- Anesthesia: Inject 1 mL to 2 mL of lidocaine with epinephrine directly underneath the papilloma. Ensure that the quantity of anesthetic used is sufficient to ensure patient comfort.
- Excision: Grasp and elevate the lesion gently with toothed forceps (Paufique forceps or 0.5mm forceps). Using either a 15-blade, iris or Westcott scissors, excise the papilloma including the base. There's typically no requirement to penetrate deeper tissues.
- Post-Excision: If any bleeding occurs, gentle pressure or a handheld cautery tool is effective for hemostasis. Given that the resulting defect is generally small, sutures are often unnecessary. Advise patients to apply a prescribed antibiotic, such as erythromycin ophthalmic ointment, on the healing incision three to four times daily for 1 to 2 weeks. This promotes healing and minimizes infection risk.
- Pathological Consideration: Always consider sending the excised tissue for pathological evaluation, especially in the presence of suspicious features.
Argon laser has been successfully used to treat benign eyelid tumors for upper and lower lids. [12] More recently, excisional biopsy of eyelid papillomatous lesions using radiofrequency techniques has been successfully described. [13]
Complications
Surgical scarring and possibly lid notching are the only likely complications. Usually, the lesions are small and bleeding and infection rarely occur postexcision.
Long-Term Monitoring
Patients should receive follow-up care as needed, and counseling regarding the possibility of recurrence should be provided.
