Pterygium

Many small pterygia cause no symptoms at all and are found at a routine eye exam. As they grow, common symptoms include:

• A visible pink or fleshy growth on the white of the eye, usually starting on the side closest to the nose and slowly creeping toward the colored part.
• Redness in or around the growth, often worse after sun, wind, dust, or air conditioning.
• Gritty, burning, or foreign-body sensation in the eye.
• Dryness or tearing.
• Blurry vision or new astigmatism if the pterygium is large enough to pull the cornea out of shape ⁶.
• Cosmetic concern from the pink raised tissue at the corner of the eye.

A pterygium grows slowly — usually over years, not days. A growth that appears suddenly, grows fast, is dark or pigmented, or starts to bleed needs a cornea specialist to rule out other diagnoses.

Pterygium is not contagious and not caused by any one thing the patient did. It develops over years from a mix of outside exposure and individual biology. The biggest risk factors are:

• UV light from the sun. Far and away the most important risk factor. Years of outdoor work or play, especially near the equator, on the coast, at high altitude, or on snow or sand, raise the risk of pterygium ².
• Wind, dust, smoke, and chemical fumes. Chronic surface irritation adds to the risk.
• Dry climate and air conditioning. Dry conjunctival surfaces are more vulnerable.
• Age. Pterygium usually appears after age 20-30 and is more common with each decade.
• Male sex and outdoor occupations (fishing, farming, construction, sailing, surfing, maritime work).
• Family history. Some families seem to be more prone.

At the cellular level, pterygium is now understood as a UV-driven proliferation of conjunctival tissue with abnormal blood vessel growth and inflammation. Newer research is mapping the molecular pathways that drive that overgrowth and looking for medical treatments ⁷.

Treatment depends on size, symptoms, and how fast the pterygium is changing. The first goal is to slow growth and quiet the eye ⁸.

Non-surgical care (most small pterygia):

• UV-blocking wraparound sunglasses every day outdoors. The single most useful thing a patient can do.
• Wide-brimmed hat in strong sun.
• Lubricating (artificial tear) drops for grittiness and dryness.
• Short courses of mild steroid or anti-allergy drops from an eye doctor for inflamed flare-ups.

Surgery (for large or vision-affecting pterygium):

• The pterygium is carefully removed from the cornea and conjunctiva.
• A small patch of the patient's own conjunctiva (a conjunctival autograft) is placed over the bare area to lower the chance the pterygium comes back. Modern network meta-analyses of randomized trials show conjunctival autograft fixation has the lowest recurrence of any pterygium surgery ⁵.
• Surgical glue or fine sutures hold the graft in place.
• In some cases, a thin medication like mitomycin C is used to lower the chance of regrowth.
• Surgery takes about 30-60 minutes and is done with eye drops or a small injection for numbing.

Recovery after pterygium surgery:

• The eye is red, gritty, and watery for 1-2 weeks.
• Antibiotic and steroid eye drops are used for several weeks.
• Most people are back to office work in a few days. Heavy outdoor work and swimming usually wait 2-3 weeks.
• Most recurrence happens in the first 6-12 months, so the eye doctor watches the eye closely during that window.

Pinguecula and pterygium are two related conjunctival changes that doctors check for together.

• Pinguecula is a yellowish, slightly raised spot on the white of the eye that does NOT grow onto the cornea. It is very common and usually harmless. It can become red and irritated in dry, windy, or sunny conditions.
• Pterygium is the same kind of overgrowth but it has crossed onto the cornea. Because it is on the clear part of the eye, it can change vision when it grows large.

Both are caused by years of UV, wind, and dry-air exposure. Many people have a pinguecula first, and a pterygium later. The same daily UV protection and lubricating drops help both ⁹.