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Pterygium – Causes, Symptoms & Treatment
A pterygium is a benign growth of conjunctival tissue that can extend onto the cornea of the eye. It is commonly caused by prolonged UV exposure and environmental irritants.
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A pterygium is a benign growth of conjunctival tissue that can extend onto the cornea of the eye. It is commonly caused by prolonged UV exposure and environmental irritants.
What Is a Pterygium?
A pterygium (plural: pterygia) is a benign, wedge-shaped overgrowth of the conjunctiva (the clear membrane covering the white of the eye) that extends onto the cornea (the transparent front surface of the eye). The name comes from the Greek word for “little wing,” describing the characteristic triangular shape of the tissue. A pterygium most commonly grows from the nasal (inner) side of the eye, though it can also develop from the temporal (outer) side. It is sometimes informally called “surfer's eye” due to its prevalence among people who spend significant time outdoors.
Causes
The exact cause of pterygium is not fully understood, but several risk factors have been identified:
- UV radiation: Long-term exposure to ultraviolet light is considered the primary risk factor.
- Dry and windy climates: Chronic irritation from wind and dry air contributes to tissue changes on the eye surface.
- Dust and environmental particles: Occupational or recreational exposure to dust and airborne particles increases risk.
- Genetic predisposition: Family history suggests a hereditary component.
- Geographic location: More prevalent in tropical and subtropical regions close to the equator.
Symptoms
In early stages, a pterygium may cause no symptoms at all. As it grows, the following signs and symptoms may appear:
- Redness and irritation of the eye
- A sensation of a foreign body or burning in the eye
- Excessive tearing
- Blurred vision or reduced visual acuity if the pterygium extends toward the center of the cornea
- A visible pinkish-white triangular growth on the white of the eye
- In advanced cases: astigmatism (irregular corneal curvature) caused by the mechanical pull of the pterygium on the corneal tissue
Diagnosis
Diagnosis is typically made by an ophthalmologist (eye specialist) using a slit lamp, a specialized microscope used for eye examinations. This allows the doctor to assess the extent of the growth and its involvement with the cornea. Additional tests may include:
- Visual acuity testing: To evaluate any impact on vision.
- Corneal topography: To measure any irregular curvature induced by the pterygium.
- Photographic documentation: To monitor the progression of the growth over time.
Treatment
Conservative Management
For small pterygia with mild or no symptoms, conservative treatment is often sufficient:
- Lubricating eye drops or gels to relieve dryness and irritation
- Anti-inflammatory eye drops (such as corticosteroids) during flare-ups
- Protective measures including UV-blocking sunglasses and wide-brimmed hats
Surgical Treatment
Surgery is recommended when the pterygium grows toward the center of the cornea, significantly affects vision, or causes persistent discomfort. The standard procedure is pterygium excision with conjunctival autograft: the pterygium is surgically removed and the defect is covered using a graft of the patient's own conjunctival tissue. This technique significantly reduces the risk of recurrence compared to simple excision alone. Mitomycin C, a medication that inhibits cell growth, may be applied during or after surgery as an adjunct to further reduce the chance of regrowth.
Prevention
Since UV radiation is the primary risk factor, protecting the eyes from sunlight is the most important preventive measure:
- Wearing sunglasses with certified UV-400 protection
- Using wide-brimmed hats when outdoors
- Avoiding prolonged exposure to dusty or windy environments without protective eyewear
References
- Coroneo MT, Di Girolamo N, Wakefield D. The pathogenesis of pterygia. Current Opinion in Ophthalmology. 1999;10(4):282-288.
- Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database of Systematic Reviews. 2016;2:CD011349.
- American Academy of Ophthalmology. Pterygium - Preferred Practice Pattern. Available at: https://www.aao.org
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