A pterygium is 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 (subepithelial 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 wraparound 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.
A 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 localized inflammation), and reduced vision (due to irregular astigmatism and occasional progressive growth of the pterygium to the visual axis/center of cornea).
History and exam
Key diagnostic factors
- wing-shaped conjunctival overgrowth onto corneal surface
- history of chronic UV light exposure
- ocular irritation, burning, and tearing
Other diagnostic factors
- altered ocular cosmesis
- blurred vision
- double vision
- chronic UV light exposure
- family history of pterygium
- chronic ocular irritants
- human papilloma and Epstein-Barr virus infection
1st investigations to order
- slit-lamp examination
- fluorescein staining
ocular irritation, burning, or itching: without visual impairment, rapid growth, or cosmesis concerns
visual impairment or rapid enlargement or poor cosmesis
David O'Brart, MBBS, DO, MD, FRCS, FRCOphth
Consultant Ophthalmic Surgeon
Guy's and St. Thomas' NHS Foundation Trust
Professor of Corneal Science
University of London
DB holds a non-commercial research grant with Rayner Ltd. through his NHS Trust for cataract surgery research within the NHS. He has equity in the medical imaging company Sparca Inc. and is on their medical advisory board. DB is currently negotiating with Johnson and Johnson for a non-commercial research grant for further cataract surgery research within the NHS. DB has held non-commercial research grants with Alcon Inc. and Avedro Inc. (now Glaukos Inc.) in the past 5 years for research within the NHS through his NHS Trust. He is an author of a number of references cited in this topic.
Carlos E. Diaz, MD
Department of Ophthalmology
University of Texas Health Science Center
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
REM declares that he has no competing interests.
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