Pterygium or Surfer’s Eye

Definition:

Pterygium is a non-cancerous, slow growing common eye condition that appears as pink, fleshy abnormal growth of tissue on the conjunctiva or mucous membrane that covers the white part of the eye. Although it grows slowly throughout life but it may either stop growing on its own to grow till it covers pupil or cornea interfering with vision.

Specific characteristics of Pterygium:

• Appearance: Raised pink, white, or red lesion
• Growth: Fleshy
• Shape: Wedge shaped
• Site: Conjunctiva
• Direction: Growth forms on inner corner of the eye close to the nose and grows toward the centre of the eye
• Affects: One or both (bilateral pterygium) eyes

Affected Population:

• People who spend a lot of time outdoors in sunny or windy environments
• People who don’t wear sunglasses or a sun hat outside
• People who live near the equator or in sunny or warm climate
• Sports people such as sailors and skiers
• Farmers and fishermen
• Light skin and light eyed individuals
• Young adults aged between 20 to 40 years
• More common in men than in women

Causes of Pterygium

• Prolonged exposure to ultraviolet light
• Dry eye
• Irritants such as dust and wind
• Excessive exposure of eye to elements like pollen, sand or smoke

Symptoms of Pterygium

In some cases, a pterygium does not cause any symptom but only appears as an extra growth. Other than this, there are certain cases in which pterygium is more than just an abnormal growth and causes following symptoms:

• Burning sensation in the eye
• Redness in the eye
• Gritty or sand like feeling
• Excessive itching
• Sensation of a foreign body in the eye
• Decreases or blurred vision
• Eye discomfort on wearing contact lens

If pterygium enlarges progressively in size and grow on to the cornea or pupil of the eye, following symptoms may occur:

• Redness and inflammation of the eye
• Distorted shape of the cornea, causing astigmatism
• Foreign object sensation in the eye
• Blurred or loss of vision

How Serious Is Pterygium?

Although most of the cases of pterygium are not serious but if it keeps on growing in size and covers cornea or pupil, it becomes a serious condition. It can lead to severe corneal scarring and can cause complete vision loss. This condition needs immediate attention and treatment with appropriate eye drops or ointment to treat inflammation. In the most serious cases of complete vision loss, corneal transplant may be required to restore some vision.

Pterygium can also be preceded by a related noncancerous condition called pinguecula which is a yellowish patch or bump on the conjunctiva near the cornea. This is a non-serious condition that can be dealt with proper eye treatment.

Tests and diagnosis for Pterygium

Diagnosis of pterygium is quite straightforward and is based on a physical examination of the affected eye and eyelid using a slit lamp. Very rarely some additional tests may be required to confirm the diagnosis including:

• A visual acuity test
• Corneal topography to measure curvature changes in cornea
• Photo documentation to track the growth rate of the pterygium

Treatment and drugs for Pterygium

Pterygium is a non-serious condition that usually doesn’t cause much problem or require treatment. It only requires treatment if it is symptomatic and causes discomfort to the patient.

Mild pterygium can be treated with following medications:

• Lubricating eye drops or ointments
• Occasional use of vasoconstrictor eye drops
• Short course of steroid eye drops

But it pterygium interferes with the vision of the patient or causes persistent discomfort; it needs to be surgically removed.

Surgical indications of Pterygium:

• Failed conservative treatment
• Progressively growing pterygium
• Reduced vision causing risk of eyesight
• Astigmatism due to pterygium
• Cosmetic appearance

Surgery for Pterygium:

The procedure involves removal of pterygium and filling of the arising empty space with patient’s own conjunctiva or preserved amniotic membrane using glue or stitches. Pterygium removal with a conjunctival or amniotic graft is associated with a much decreased recurrence risk of 5%-10%.

The procedure hardly takes 30 to 45 minutes and is performed as an outpatient procedure. Patient is required to wear an eye patch for a day or two and thereafter can return to work or normal activities in a few days. Steroid eye drops are prescribed for several weeks or months to reduce inflammation and the chance of pterygium recurrence.

Risks associated with Pterygium surgery:

• Pterygium can return after being surgically removed in a more aggressive form if surgery is performed without a conjunctival or amniotic graft (50% chances)
• Dryness and irritation in eye after surgery

Surgical complications of Pterygium surgery:

• Corneal scarring
• Perforation of the white part of the eye
• Astigmatism