A pterygium is an abnormal, wing shaped mass of thickened conjunctiva extending from the white part of the eye onto the cornea (the clear front window over the colored part of the eye). The conjunctiva is a thin cream-colored, skin-like layer of tissue that covers the white part of the eye.
There are many factors that together contribute to the growth of a pterygium. There is a direct correlation between people who have Pterygia and the environment in which they live or work. The prevalence of people with Pterygia increases with proximity to the equator. The main factors which stimulate growth are long term exposure to ultra-violet (UV) light, and other factors which cause chronic irritation or inflammation of the ocular surface. These include airborne irritants such as pollen, dust, smoke, wind or chronic irritation due to dryness of the eye.
A pterygium may initially be treated medically. It is important to make an effort to reduce exposure to environmental factors that cause chronic inflammation or irritation of the eye. Secondly, to improve the quality of the moisture layer, which coats the eye (the tear film); a religious hot compress/lid hygiene routine may be undertaken. There are additional treatments that may be considered to further improve the stability of this complex, multi-layered, tear film. Artificial tear moisture drops may be used to decrease periodic bouts of redness and irritation. Additionally, a mild steroid eye drop is sometimes added to further reduce the chronic inflammation. Keep in mind, none of these treatments gets rid of a pterygium; they are used to limit the irritation caused by the elevated nature of the growth or as an attempt to slow or halt the growth of it.
Surgical intervention is the only way to remove a pterygium. Should the pterygium continue to grow, cause increased irritation, cosmetic problems, or threaten sight, surgery may be performed. If sight is already affected, surgical excision should be undertaken to remove it.
There are several surgical approaches available to remove a pterygium. The preferred method includes the use of a conjunctival transplant to cover the exposed area that is created with the surgical removal. Other methods include the use of a chemical applied to the ocular surface at the time of surgery or use of radiation following surgery. The use of a conjunctival graft greatly reduces the chance that the growth may recur. Following surgery, limitation of environmental exposure is also a very important way to decrease the stimulation for re-growth.
Surgery is performed under local anesthesia, in an outpatient surgery center. Medical clearance is usually necessary to be obtained prior to surgery. Intravenous medications are given to help you to be more relaxed at the time of surgery. You should feel minimal discomfort during the procedure. The pain following the surgery varies from person to person but is usually described as moderate the first night, with a scratchy foreign body sensation due to the stitches, and quickly decreases over the following several days. Activities are restricted for 4 to 5 days, especially regarding strenuous activities. Some limitations remain for up to two to three weeks, (including swimming); in order to assure the transplant tissue remains in proper position. An eye patch and shield are worn the first night after surgery. They are to be left in place until your visit on the day after the operation. The shield must be worn after that, only when asleep and eye protection should be worn at all other times for the first couple of weeks. Vision in the operated eye is usually quite blurry the first week, improving steadily thereafter. Depending on your occupation, you may return to work as soon as 4 to 5 days after surgery or be out as long as 2 to 3 weeks.
An extended-wear, soft contact lens is placed over the eye at the end of the operation, to cover the cornea and some of the stitches, to make you more comfortable and to help in the healing process. You do not need to handle this contact lens. It is usually removed two to three weeks after the procedure at which time your vision should be returned almost to what it was prior to surgery. After this point you may resume most of your normal activities. The sutures absorb on their own. Occasionally, a few may need to be removed in the office. The transplant heals in place and whitens to a cream-colored appearance over the next several weeks. Vision continues to improve over 2-3 months at which time you may need to be re-fit with eyeglasses or a contact lens as your prescription may have changed as a result of surgery.
Although risks are rarely sight threatening, results cannot be guaranteed. Some of these include infection, scarring, irregular healing of the corneal surface or conjunctival graft and recurrence of the growth. Very rarely encountered problems include retinal detachment and glaucoma. Our effort is to prevent these things from happening. The vast majority of people having this type of surgery heal extremely well with improved comfort; improved cosmetic appearance and vision back to the pre-operative level or better.