Pterygium

A pterygium (pronounced "teh-RIJ-ee-um") is a wedge-shaped, fleshy growth of conjunctival tissue that extends from the white of the eye onto the cornea. Often called "surfer's eye," it is strongly associated with ultraviolet (UV) light exposure. While typically benign and slow-growing, a pterygium can cause irritation, cosmetic concern, and vision problems if it grows across the visual axis or induces significant astigmatism.

Pterygium vs. Pinguecula

Feature	Pterygium	Pinguecula
Location	Extends onto the cornea	Stays on the conjunctiva only
Shape	Wedge/wing-shaped	Raised yellow bump
Growth	Can grow progressively across cornea	Rarely grows significantly
Vision effect	Can cause astigmatism, block vision	Rarely affects vision
Surgery	More often needed	Rarely needed

A pinguecula can sometimes progress to become a pterygium, though this is not common.

Symptoms

• Visible fleshy growth on the white of the eye (usually nasal side)
• Redness and irritation around the growth
• Gritty or foreign body sensation
• Dryness in the affected area
• Blurred vision if the growth induces astigmatism or approaches the pupil
• Cosmetic concern — many patients seek treatment for appearance
• May be asymptomatic in early stages

Causes and Risk Factors

Primary Cause

UV light exposure is the dominant risk factor. UV radiation damages the conjunctival stem cells at the limbus (the border between cornea and conjunctiva), triggering abnormal tissue growth.

Risk Factors

• Prolonged sun exposure — outdoor occupations, tropical/equatorial climates
• Wind and dust exposure
• Dry, arid environments
• Male sex (due to higher occupational sun exposure)
• Ages 20-50 (develops from cumulative UV exposure)
• Not wearing sunglasses regularly
• Living near the equator (within the "pterygium belt" — 37°N to 37°S latitude)

Diagnosis

• Slit-lamp examination — clearly visualizes the growth, its extent onto the cornea, and any iron deposition (Stocker line)
• Corneal topography — measures the astigmatism induced by the pterygium pulling on the cornea
• Visual acuity testing — to document any vision impact
• Photography — to document size and track growth over time

Treatment

Conservative Management

For small, asymptomatic pterygia:

• Lubrication — artificial tears for irritation and dryness
• Anti-inflammatory drops — short courses of mild steroid drops for inflamed, irritated pterygia (pingueculitis/pterygium inflammation)
• UV protection — sunglasses and hats to slow progression
• Monitoring — periodic measurement to track growth

Surgical Removal

Indications for surgery:

• Growing toward or onto the central cornea (threatening the visual axis)
• Inducing significant astigmatism (confirmed on corneal topography)
• Chronic irritation not controlled with drops
• Cosmetic concern
• Restricting eye movement (rare, very large pterygia)

Preferred technique — Pterygium excision with conjunctival autograft:

1. The pterygium is carefully dissected from the cornea and conjunctiva
2. A thin graft of healthy conjunctiva (from under the upper eyelid) is placed over the bare area
3. The graft is secured with tissue glue (fibrin) or fine sutures
4. This technique has the lowest recurrence rate (<5%)

Alternative: Pterygium excision with mitomycin C (MMC):

• Anti-metabolite applied to the surgical bed
• Reduces recurrence by inhibiting regrowth
• Used when autograft tissue is limited or in revision surgery

Recovery After Surgery

• Mild discomfort for several days
• Eye may be red for 2-4 weeks
• Avoid dusty/windy environments during healing
• Steroid and antibiotic drops for several weeks
• Full healing takes 1-2 months
• Final cosmetic result improves over months

When to See a Doctor

Prevention

• Wear UV-blocking sunglasses outdoors — wraparound styles offer the best protection
• Wear a wide-brimmed hat
• Avoid unnecessary sun exposure, especially midday
• Protect eyes from wind and dust
• Use lubricating drops if your eyes are frequently dry or irritated outdoors

Frequently Asked Questions

Is a pterygium cancerous?

No. Pterygia are benign growths. However, rarely, other growths on the eye surface can mimic a pterygium. Your ophthalmologist can distinguish between them. Tissue removed during surgery is typically sent for pathological examination.

Will my pterygium grow back after surgery?

With modern conjunctival autograft technique, the recurrence rate is less than 5%. Recurrence is more likely in younger patients and those with continued heavy UV exposure. Wearing sunglasses after surgery is important.

Can I just leave it alone?

Many pterygia are small, stable, and asymptomatic — these can be safely monitored. Surgery is recommended when the growth threatens vision, causes significant symptoms, or is cosmetically bothersome.

Does a pterygium affect contact lens wear?

Yes. A pterygium can make contact lenses uncomfortable or cause them to fit poorly. It may also prevent fitting of some lens types. After surgical removal and healing, contact lens wear can usually resume.

How long does pterygium surgery take?

The procedure typically takes 30-45 minutes and is performed under local anesthesia as an outpatient procedure. Most patients return to normal activities within a week, though complete healing takes longer.

References