Pterygium

What is it?

A pterygium is a growth of fibrous tissue and blood vessels from the conjunctiva (the loose skin on the white of the eye) onto the cornea (the clear ‘window’ of the eye).

It usually grows slowly, and many never grow more than 1-2mm onto the cornea; but sometimes a pterygium can approach the centre of the cornea where it blocks the light and affects the vision.

What causes it?

The most likely cause is exposure to UV light, and it is more common in people who have spent many years living in hot sunny countries or working outdoors – so much so that it has been called ‘sailor’s eye’, ‘farmer’s eye’ and ‘surfer’s eye’. 

Does it need to be treated?

Only if it is causing symptoms, either by being uncomfortable, or by interfering with vision. Many pterygia cause no problems and can safely be left alone.

How is it treated?

If the pterygium is causing discomfort, usually by drying out, then lubricating drops or gels may be all that is needed. If the dryness makes the pterygium inflamed, a short course of steroid drops may be necessary.

For more severe symptoms, such as interference with vision, the best option is surgery to remove the pterygium.

What does the surgery involve?

The pterygium is carefully peeled off the cornea, and any abnormal tissue in the conjunctiva is removed at the same time. This leaves a bare patch of sclera, which is then covered with a patch of conjunctiva taken from the upper part of the same eye, underneath the upper eyelid. Without this graft, there is a high risk of the pterygium recurring (up to 50%).

The operation is usually performed under local anaesthetic, with the patient awake but the eye numbed; but can also be performed under general anaesthesia.

How long will the recovery take?

The eye will be red and uncomfortable for a week or two after the operation, and regular antibiotic and steroid eyedrops will be required; but most people find they can return to normal activities after a few days. It takes 2-3 months for the redness over the surgical site to settle and for the eye to return to a normal appearance.

What happens after surgery?

The pad can be removed the morning after surgery, and the skin around the eye gently bathed with cooled, boiled, water. The pad may be blood-stained or sticky – this is normal. Antibiotic ointment is then needed for a couple of weeks, and steroid eye-drops for up to three months after surgery.

It’s best not to swim for two weeks after surgery, and to keep the eye as dry as possible when showering or washing hair. The eye will be scratchy and sore for the first few days, but should slowly settle. Normal painkillers can be taken.

What complications can occur?

As with any operation, there is a small risk of infection or bleeding. The pterygium can recur after surgery, although the grafting technique reduces this risk from 50% to 5-10%. If the pterygium does recur, it may be more aggressive and harder to treat.

When removing a very large pterygium, there is a risk of damage to the surface of the eye, or to the muscles which move the eye. In this case, further surgery may be needed.

What is the usual outcome of surgery?

Normally, the eye heals well after pterygium surgery, the white of the eye slowly settling, and leaving only a faint scar on the cornea.