Pterygium

Last reviewed: September 2018

Last updated: January 2018

Summary

A wing-shaped fibrovascular overgrowth from the conjunctiva onto the corneal surface. Occurs in the interpalpebral region, usually from nasal side, and is often bilateral.

Consists of a cap (sub-epithelial arc-shaped corneal opacity at the leading edge), head (white fibrous mass attached to cornea), and body (fleshy, triangular-shaped fibrovascular tissue continuous with the conjunctiva at its base).

Typically, there is a history of excessive chronic UV light exposure. Often found in people with outdoor occupations, surfers, sailors, or people living within 40° latitude of the equator.

Symptoms include impaired ocular cosmesis, ocular irritation, and reduced vision.

All patients should use ocular UV protection such as wrap-around sunglasses and wide-brimmed hats. If symptomatic, topical lubricants may help.

Surgical intervention is indicated if significant ocular irritation persists despite medical therapy; or if there is impaired ocular cosmesis, reduced visual acuity, continued progression, or double vision.

Surgical removal is generally successful, but some symptoms may persist and pterygium can recur.

Definition

eA pterygium (from the Greek pterygion , meaning wing) is a triangular-shaped fibrovascular overgrowth onto the corneal surface, continuous at its base with the conjunctiva. It occurs in the interpalpebral region usually from the nasal side and is usually bilateral. Symptoms include impaired ocular cosmesis, ocular irritation (caused by tear film disturbances over the pterygium and localised inflammation), and reduced vision (due to irregular astigmatism and occasional progressive growth of the pterygium to the visual axis/centre of cornea).

History and exam

Key diagnostic factors

wing-shaped conjunctival overgrowth onto corneal surface
hx of chronic UV light exposure
ocular irritation, burning, and tearing

Full details

Other diagnostic factors

altered ocular cosmesis
blurred vision
double vision

Full details

Risk factors

chronic UV light exposure
FHx of pterygium
chronic ocular irritants
human papilloma and Epstein-Barr virus infection

Full details

Diagnostic investigations

1st investigations to order

slit-lamp examination
fluorescein staining

Full details

Treatment algorithm

ACUTE

asymptomatic

ocular irritation, burning, or itching: without visual sx, rapid growth, or cosmesis concerns

visual impairment or rapid enlargement or poor cosmesis

ONGOING

recurrent pterygia

Contributors

Authors VIEW ALL 

David O'Brart, MBBS, DO, MD, FRCS, FRCOphth

Consultant Ophthalmic Surgeon

Guy's and St. Thomas' NHS Foundation Trust

Professor of Corneal Science

Kings College

University of London

London

Disclosures

DOB receives research grants from Alcon Inc, and has acted as a consultant on the preparation of a report on epithelium-on-corneal collagen cross-linking for Sooft Italia SPA. He is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL 

Carlos E. Diaz, MD

Assistant Professor

Department of Ophthalmology

University of Texas Health Science Center

San Antonio

Disclosures

CED is a speaker for Bio-Tissue, the developer of Amniograft amniotic membrane.

Robert E. MacLaren, DPhil, DipEd, FRCOphth, FRCS

Professor of Ophthalmology

Nuffield Laboratory of Ophthalmology

University Of Oxford

John Radcliffe Hospital

Oxford

Disclosures

REM declares that he has no competing interests.

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Pterygium

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Treatment algorithm

asymptomatic

ocular irritation, burning, or itching: without visual sx, rapid growth, or cosmesis concerns

visual impairment or rapid enlargement or poor cosmesis

recurrent pterygia

Contributors

Authors VIEW ALL 

David O'Brart, MBBS, DO, MD, FRCS, FRCOphth

Disclosures

Peer reviewers VIEW ALL 

Carlos E. Diaz, MD

Disclosures

Robert E. MacLaren, DPhil, DipEd, FRCOphth, FRCS

Disclosures

Differentials

Guidelines

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