Pterygium Surgery

What is a pterygium?

Pterygium is a degeneration of the limbic conjunctiva that grows over the surface of the cornea towards the pupil. For this reason, patients often refer to pterygium as a kind of “grown flesh in the eyes” or simply, “flesh in the eyes”.

Pterygium in the eye is a lesion that usually grows slowly throughout life. It may even stop growing at a certain point. In advanced cases, the pterygium can grow so large that it covers the pupil and interferes with vision.

Ocular pterygium can vary from a small lesion to large, aggressive or fibrovascular lesions that can distort the topography of the cornea and in advanced cases can occlude the optic center of the cornea.

It is a disease that usually affects people who spend a lot of time outdoors, exposed to wind and sun, and can affect one or both eyes (bilateral pterygium).

Pterygium is usually not a serious problem. It can, however, cause some symptoms and quite unpleasant signs.

Symptoms in Pterygium

In pterygium, usually, there are several signs and symptoms that can be more or less exuberant according to the evolution of the disease. In certain circumstances, pterygium is even asymptomatic (without symptoms). Among the most common symptoms we can include:

Foreign body sensation in the eye;
Blurred vision;
Itchy eye;
Burning sensation.

A pterygium in an advanced stage can cause red eyes and inflammation in the eye.

The pterygium can progressively grow over the cornea (the clear, outer layer of the eye), and can distort the cornea, causing astigmatism.

Causes of pterygium

The causes for the appearance of pterygium can be the following:

Prolonged exposure to ultraviolet light (sunlight without sunglasses)
Dry eye;
Irritants such as dust and wind.

Pterygium is most common in young adults between the ages of 20 and 40 and appears to be more common in men than women. Pterygium in the eye is often preceded by another degeneration of the conjunctiva called a pinguecula. Pinguecula is a kind of yellowish neoformation in the conjunctiva near the cornea and presents the same risk factors as pterygium, especially frequent exposure to the sun without sunglasses. Since the pinguecula can prevent tears from covering the ocular surface evenly, it can cause dry eye and foreign body sensation in the eye. The pinguecula may also become reddish.

As for pterygium prevention, sunglasses can provide the best protection against ultraviolet light, dust, and wind. It’s important to protect your eyes while driving too, because, unlike the front windshield, most car side windows do not provide adequate UV protection. Even on cloudy days, ultraviolet light can penetrate through clouds. Choose sunglasses that offer good protection against ultraviolet rays.

Pterygium treatment

Pterygium usually does not require treatment if the symptoms are moderate. If there is a temporary aggravation of the problem, we must treat the pterygium with anti-inflammatory eye drops.

In certain circumstances, surgical treatment is necessary. See below under what conditions we should resort to surgical treatment of the disease.

The use of pterygium surgery should only be considered in certain circumstances. Surgery consists of removal or excision of the pterygium.

The pterygium operation should be considered in the following circumstances:

Conservative treatments failed;
The patient’s visual acuity is compromised;
The patient is uncomfortable with the aesthetic appearance.

Surgery sometimes uses the patient’s own conjunctiva or preserved amniotic membrane (placenta) to fill in the empty space created by removing the pterygium. In this procedure the pterygium is removed and the amniotic membrane or conjunctiva is placed and sutured in the affected area.

Pterygium surgery with conjunctiva or amniotic membrane transplantation is usually performed under local anesthesia and takes about 30 minutes.

Pterygium surgery – risks, complications

In pterygium surgery, among the main risks and complications is recurrence after removal or excision of the pterygium.

Without a conjunctival or amniotic graft, the rate of recurrent pterygium can be high (about 30%). Removing a pterygium with a conjunctival or amniotic graft is associated with a lower risk of recurrence, which can fluctuate between 5% and 10%.

Surgical complications can also include scarring of the cornea and perforation of the white part of the eye. In some cases, surgical removal of pterygium can induce astigmatism.

Post-operative in pterygium surgery

In pterygium surgery, the postoperative period is not painful. Patients are often advised to use steroid eye drops for several weeks or months, which may reduce inflammation and the likelihood of the pterygium coming back.

Patients need to be carefully followed for one year. About 97% of recurrences occur during the first 12 months after surgery.

Recovery from pterygium surgery

In pterygium surgery, the recovery and rest time is short, and patients can resume work or normal activities a few days after the operation.

However, some additional care is needed in the first days after pterygium surgery. Patients generally need to wear an occluder in the operated eye during the first two days (48 hours) in order to prevent possible risks of infection.