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Pterygium & Pinguecula

Pterygium & Pinguecula

What is a pterygium?
A pterygium (plural pterygia) is a wedge shaped growth of abnormal tissue found on the white of the eye, between the eyelids. Ninety percent are found at the corner closer to the nose. Pterygia are benign (non-cancerous) growths that may enlarge to extend on to the cornea (clear window of the eye).

When do pterygia occur and how frequently?
Pterygia are most commonly found between the ages of 20 and 50 years. They are more commonly seen in men but this may relate to their cause (see below). There is a low frequency of hereditary factors in their incidence but a high association with climate. The incidence is 22% in equatorial regions and less than 2% above latitude 40 degrees.

 

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What is the cause of my pterygium?
It is thought that chronic exposure to environmental elements damages the tissue of the conjunctiva causing a thickening of scar tissue containing blood vessels. Studies have shown that there is a high association between pterygia and ultraviolet light, a dusty environment, absence of sunglasses and not wearing a hat.

Who gets Pterygia
People who live in tropical climates and spend a lot of time outdoors. Sports people such as sailors and skiers where there is a lot of reflected ultraviolet light. Populations living where there is ozone layer depletion. The association with dirty dusty environments may account for the higher incidence in men.

What is the natural course of the condition of pterygia?
This is variable. Pterygia may occur in one or both eyes and at different rates of growth. They tend to be progressive and grow across the cornea and this tends to be associated with more symptoms and visual disturbance (see below). Sometimes they may stop growing, become quiescent, and remain this way.

What are the signs and symptoms of pterygia?
A pterygium appears as a fleshy pink growth and may be seen to extend on to the clear cornea. Initial symptoms may be irritation, dryness and a foreign body sensation associated with inflammation and redness. These may be more frequent during the summer, in air conditioning or a dry environment such as in front of a heater. Once the pterygium involves the cornea the vision may become affected because the curvature of the cornea becomes distorted. 

Medical management or treatment of ptergium and pinguecula
Protection from the environment and ultraviolet light by means of sunglasses and hats will minimise onset and progression of these growths. Symptoms may be alleviated by use of lubricating and decongestant drops such as Tears Plus or Albalon. If there is significant inflammation a course of non-steroidal anti-inflammatory drops may help (eg Ocufen, Acular, Voltaren Ophtha). Steroid eye drops should be used only under close supervision of your ophthalmologist as they may have side effects such as glaucoma.


Pterygium removalIndications for pterygium surgery:
• Significant uncontrolled irritation and redness 
• Poor appearance 
• The pterygium is beginning to affect the vision 
• Interference with the wearing of contact lenses

Surgical techniques for pterygium
The preferred modern technique for pterygium surgery is to remove the pterygium and cover the area with a patch of healthy conjunctiva from underneath the upper lid. This is sutured into place. This is done under local anaesthesia and takes about half an hour. It is a relatively comfortable procedure. A pad is placed over the eye and you will need transport home. For about three days the eye will be scratchy and you will need a day or two off work. Drops are instilled for about a month and the eye will be red for at least two weeks. The stitches fall out by themselves. The recurrence rate for this technique is around 5%. If there was significant corneal distortion before surgery some may persist afterwards. Glasses may need upgrading after successful pterygium surgery. This is due to removal of the distorting influence of the pterygium. If the pterygium reaches too near the centre of the cornea, a full visual recovery cannot be assured.

Bare sclera technique. Here the pterygium is removed. Some superficial weak Beta-ray radiation is applied and the area is allowed to heal without any graft or suturing. Because the recurrence rate following this technique is up to 30%, it is now seldom used.



PingueculaPinguecula
As can be seen, pingueculae and pterygia are similar and are commonly confused as they both occur at the inner corner of the eye. Pingueculae, however, also occur on the white surface (conjunctiva) at the outer corner of the eye. Pinguecula (-ae pl)

How do pingueculae differ from pterygia? 
Pingueculae are raised creamy coloured chalky growths confined to the conjunctiva. They do not grow across the cornea to affect the vision, but may occasionally turn into pterygia. Under the microscope pterygia and pingueculae are similar...

What is the cause of pinguecula?
They are age related and also caused by ultra-violet light and environmental factors like pterygia.

Medical management for pterygia is the same as for pterygia