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Pterygium and Pinguecula

A pinguecula and a pterygium are growths on the conjunctiva, the thin clear skin over the white of the eye. Both come from years of sunlight, wind and dust, and both are benign: they are not cancer. A pinguecula stays on the white of the eye. A pterygium (said "te-RIJ-ee-um") grows onto the cornea and can affect vision. It is sometimes called surfer's eye.

Press Play to see the difference, and what surgery does.

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Pinguecula

  • A yellowish, slightly raised spot on the white of the eye, usually on the side nearest the nose
  • Very common from middle age on
  • Usually causes no symptoms. It can become red, swollen and irritated from time to time.
  • It does not grow onto the cornea and rarely needs to be removed

Pterygium

  • A fleshy, pink, wedge-shaped growth with visible blood vessels, pointing toward the pupil
  • Grows slowly over years; some stop on their own
  • Symptoms: redness, a gritty or burning feeling, dryness, and the look of it
  • Effect on vision: as it advances it pulls on the cornea and changes its curve, causing astigmatism and blur. If it reaches the center it blocks vision directly.

Who gets them

  • People who have spent years outdoors: farming, fishing, sailing, surfing, construction, landscaping
  • People who grew up in sunny, dry or dusty places, especially near the equator
  • More often men, and more often with age

Looking after it

  • Sunglasses that block UV, ideally wraparound, and a hat with a brim. This is the main way to slow growth and to prevent a return after surgery.
  • Artificial tears for dryness and irritation. See Choosing Artificial Tears.
  • A short course of an anti-inflammatory drop for a red, inflamed flare.
  • Avoid "get the red out" drops, which make redness rebound.
  • Regular checks, with a measurement of how far onto the cornea it reaches.

When surgery makes sense

  • It is growing toward the center of the cornea
  • It is causing astigmatism or blurring vision
  • It stays red and irritated despite drops
  • It interferes with contact lens wear
  • It needs to be removed before cataract surgery, because it distorts the measurements used to choose the lens implant
  • Its appearance bothers you

The surgery

Pterygium surgery is an outpatient procedure that takes about 30 to 45 minutes, with numbing and light sedation.

  1. The pterygium is lifted off the cornea and removed, along with the abnormal tissue beneath it.
  2. The bare area is covered with a graft of your own conjunctiva, a thin piece taken from under the lower eyelid of the same eye, where it is not missed. The conjunctiva under the upper lid is left untouched, because it is the site used for glaucoma surgery such as a trabeculectomy and needs to stay healthy in case that is ever needed.
    • Instead of your own tissue, a graft of amniotic membrane can be used: a thin, specially prepared donor tissue, from the inner lining of the placenta after a planned cesarean birth, that calms inflammation and helps the surface heal.
  3. The graft is fixed with tissue glue or very fine stitches that dissolve.
  4. A medicine that discourages regrowth (mitomycin C) is sometimes applied.

The graft is the important part. With the old method of simply cutting the pterygium away, about half grew back, often worse than before. With a graft, the rate is roughly one in ten to twenty.

Recovery

  • The eye is red and scratchy for a few weeks. The redness fades over one to two months.
  • Steroid and antibiotic drops are used for about a month, tapering down. The Post-Op Schedule page can make a printable chart.
  • A patch or shield is worn the first night.
  • Avoid rubbing, swimming, dusty work and heavy lifting for a couple of weeks.
  • Wear sunglasses outdoors, for good. Sun exposure is the main reason a pterygium returns.
  • Steroid drops can raise eye pressure, so pressure is checked during recovery. This matters most if you have glaucoma.

Call the office if

  • Pain is getting worse instead of better
  • Vision drops
  • The graft looks as if it has moved, or there is discharge
  • Redness and growth return in the months afterward

Questions worth asking

  • Is mine growing, and how close is it to the center?
  • Is it affecting my glasses prescription?
  • Would you use my own tissue or amniotic membrane, and glue or stitches?
  • How long will the eye stay red?