Pinguecula

These are raised areas of protein, fats or calcium on the conjunctiva typically seen at 3 and 6 o’clock positions. and do not grow or extend onto the cornea. Technically they are classed as degenerative conjunctival lesions.

Signs/Symptoms

  • Patient often attend having suddenly “noticed raised lumps on their eyes” but these are normally longstanding- the reason they are now more noticeable to the patient is down to anther cause- possibly dry eye- making them slightly red and inflamed in appearance (pingueculitis).
  • They can usually be seen in both eyes (bilateral) adjacent to the limbus.
  • Slightly yellowish in appearance.
  • Develop as part of the normal ageing process but can be associated with unprotected exposure to sunlight.
  • Incomplete blinking can cause irritation of the pinguecula and associated inflammation- likewise the pinguecula can interfere with the tear film and cause dry spots on the conjunctiva at 3 and 9 0’clock aggravating the condition.

Causes

  • Ultraviolet exposure is believed to be the prime cause of pinguecula.
  • Excessive screen use may have an influence due to reduction in blink rate and associated sectorial dry eye.
  • Dry eye disease.
  • GP or hard contact lenses wear over many years.
  • Working in dry, dusty environments.

Picture show a classic pingueculum- raised, slightly yellowish appearance and positioned in the 3 o’clock nasal area.

Treatment

  • Protection from UV- good well-fitting sun spectacles are to be recommended
  • Lubricating drops or ointment will have a positive effect
  • Cool compresses
  • In cases of persistent inflammation with associated discomfort referral for the prescribing of topical steroids to reduce inflammation may be appropriate but this is not a common event.
  • Can be removed surgically or by lased but rarely performed

Red Flags

  • Conjunctival intraepithelial neoplasia may look similar to a keratinised pinguecula

When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service (HES).