Pterygium

This is a growth on the conjunctiva which encroaches on to the cornea- it is often described to patients as a pinguecula that is growing. Position is similar to that of pinguecula.

Signs/Symptoms

  • Bilateral- more often nasally positioned.
  • Vascularized appearance.
  • Starts with a thickening at the bulbar conjunctiva which scars and corneal opacities appear near the limbus. The conjunctiva then grows over the scarring and opacities and encroaches onto the cornea.
  • Slit lamp viewing may show Stockers Line (epithelial iron deposits) ahead of an advancing pterygium.
  • Mild foreign body sensation.
  • Patients are often unhappy with the cosmetic appearance particularly in long standing pterygium that have encroached noticeably onto the cornea.

Causes

  • Ultraviolet exposure is believed to be the prime cause of ptygeria.
  • Excessive screen use may have an influence due to reduction in blink rate and associated sectorial dry eye.
  • Dry eye disease.
  • Injury of bulbar conjunctiva.

Vascularised pterygium extended across limbal area into cornea.

 

 

In this picture the pterygium is more inflamed and the corneal opacity is more visible.

Treatment

  • As per pinguecula.
  • Avoidance of UV light- good quality, well-fitting sun spectacles.
  • Lubrication.
  • May require referral if growth starts to impinge on visual axis or induces irregular astigmatism.
  • Size and position of pterygium should be noted on patients records.
  • Rarely- surgical excision.

Red Flags

  • Rapid growth.
  • Sudden appearance- ocular surface neoplasm can mimic pterygia.
  • A recent study in Australia found that a person with a pterygium is 24% more likely to develop malignant melanoma of the skin.

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).