Online Photo Diagnosis

Photo Clinic CL Spectrum, Viral Wart

By William Townsend, OD, FAAO

The white lesion at the margin of this patient's eyelid is a viral wart treated moments earlier with dichloroacetic acid. The acid destroys the lesion and permits growth of normal epithelium thereafter.

Warts are lumps of tissue that result from infection and replication by viruses. These lesions are a common finding in older individuals and are caused by the human papilloma virus (HPV). Inoculation precedes appearance of the wart by two to nine months, and up to 50 percent of these lesions disappear without treatment within two years of their appearance. Lesions caused by Molluscum contatagiosum, a pox virus, are not warts.

While eyelid warts are often asymptomatic, some individuals experience itching and may present with a follicular conjunctivitis. Treatment may be accomplished through excision with scissors, focal treatment with freezing or with chemical cautery. Others have reported using argon laser to destroy these lesions. Our experience with chemical cautery has been excellent with minimal recurrence of the lesions after treatment.

It is possible for a strain virus to produce warts on divergent epithelial surfaces. Using polymerase chain reaction analysis, it's now possible to identify the specific strain of virus that causes a wart. Peck et al. (2006) reported evaluating a patient whose genital and eyelid warts were caused by identical strains of the same virus.

References

• Schornack MM., et al. Ocular manifestations of molluscum contagiosum. Clin Exp Optom. 2006 Nov;89(6):390-3.
• Ruban JM. Treatment of benign eyelid conditions with Argon laser. J Fr Ophtalmol. 2003 Jan;26(1):88-91.
• Peck N, Lucarelli MJ, et al. Human papillomavirus 6a lesions of the lower eyelid and genitalia, Ophthal Plast Reconstr Surg. 2006 Jul-Aug;22(4):311-3.