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A pterygium is an unsightly, irritating fibrovascular tumor of the conjunctiva. It starts out as a pingueculum, which is a yellow bump on the white of the eye. Pterygiums most often occur on the nasal part of the eye and grow onto the cornea, thus covering part of the colored a portion of the eye (iris). This makes your eye lose its normal, round, appearance. The pterygium is usually red and may be slow growing, or may be very aggressive and grow quickly. When the eye gets red and irritated for any reason, a pterygium will become the reddest part of the eye. This makes treating chronic and recurrent causes of red eyes an integral part of treating a pterygium. When a pterygium is inflamed, it swells and rises above the surface of the eye. A dry area develops on the cornea where the raised pterygium inserts. This dry area causes the cornea to be irritated in the short term and to develop scarring over the long-term. The pterygium tends to grow over the irritated area in front of it. Eventually it may grow over the visual axis of the eye, which is in front of the pupil. This will cause permanent visual loss of varying degrees. It is important to prevent this from ocurring. A pterygium can contain enough scar tissue to pull on the cornea and distort it. This will cause irregular astigmatism (changes to the normal round spherical shape of the eye) with visual loss. Surgical removal of the pterygium can reverse this visual loss if done before scarring of the visual axis occurs.
Pterygiums are usually benign. However, certain cancers (squamous cell carcinoma and carcinoma-in-situ) can look like a pterygium. A careful examination at our office can evaluate this possibility.
A pterygium usually occurs in the part of the eye that is most exposed to the environment. When blinking occurs, the last part of the eye that the eyelid covers is the area of the pterygium. If you have had cosmetic surgery and your eyes do not close all the way (lagophthalmos), there is more exposure, causing added redness, irritation and growth. Experts believe UV light, dust, low-humidity and wind, along with airborne environmental toxin exposure, are the likely causes of a pterygium. Genetics may also play a part.
There are non-surgical and surgical approaches to the treatment of a pterygium.
Sunglasses with UV blocking are an important addition to daily outdoor activity. They protect the eyes from wind, dust and toxin exposure. Wear a brimmed hat.
The use of thick artificial tears helps to avoid dryness. If the use of these regular tears with preservatives causes stinging, switch to non-preserved preparations.
Avoid long-term use of drops that advertise they are for the relief of red eyes ("get the red out"). The use of these drops may produce temporary relief of redness; however, they produce a "rebound effect", causing redness that is frequently worse than before the drop was used. Anti-redness drops produce resistance, so that relief lasts for shorter time intervals and usage becomes more frequent. These drops contain preservatives and while these preservatives make storage of the drops safer, they are actually detergents, like laundry soap. They destroy the integrity of the tear film of the eye, leading to dry eyes and more of the chronic inflammation that makes a pterygium worse.
Treat any cause of chronic red eyes that may be present. These include poorly fitting contact lenses, allergies, dry eyes, Rosacea, chronic infections such as blepharitis, trauma from eye rubbing, wind, exposure to ocean or pool water, makeup and perfume. Total elimination of these conditions may not be possible. However, avoiding them may reduce the inflammation and significantly decrease the symptoms of a pterygium.
Contact lenses that fit poorly should be refit. If the problem is due to ocular surface disease, wear contacts for a shorter amount of time and use disposable contact lenses. Daily disposable contact lenses of superior quality are becoming much more affordable. Consider the use of glasses or laser vision correction if contacts are rubbing against the pterygium.
If the above measures do not help, avoid or limit the duration of activities that are irritating to the eyes. These activities include prolonged reading and computer use, surfing, running, bicycling, hiking, skiing, fishing, boating etc. If avoidance is not possible, and use of the above non-surgical treatments is ineffective, surgical options may be necessary.
The surgical treatments for managing a pterygium have vastly improved over the last decade. In the past, recurrence rates after surgical excision were as high as 20% to 50%. The procedure was frequently painful. The fact that more than 20 different methods were used by various surgeons testified to the fact that none of the procedures was clearly superior.
Modern pterygium surgery, as practiced by Dr. Reiter, includes pterygium removal with ocular surface reconstruction using an amniotic membrane graft or a conjunctival autograft. These procedures leave a comfortable, quiet eye with re-growth rates that are less than 3 to 5%.
After pterygium removal from an eye, it is important to reconstruct a new disease-free ocular surface in order to minimize the risk of re-growth of unwanted tissue. Over the past years, an exciting new technique has been perfected using amniotic membranes and tissue glue instead of sutures. Amniotic membranes normally function to protect a baby in the womb from dangers caused by interaction between the baby in its placenta and maternal environment. These membranes are frozen and made available, with FDA approval, for use as a tissue replacement in eye surgery. Use of an amniotic membrane graft in pterygium surgery is a unique way of providing your eye with a protective healing environment. While there are no stem cells present (or any other living material), amniotic membranes have the property of reducing pain, inflammation and scarring while preventing the growth of new blood vessels. Using amniotic membranes saves the normal conjunctiva from other parts of your eye, used in autografting for other uses. A conjunctival autograft is used if amniotic membrane grafts are contraindicated or by patient request.
Both amniotic membrane grafts and conjunctival autografts are attached to the new empty surgical space by tissue glue. There are no sutures to remove or cause irritation.
The surgery is painless and performed while the patient is in a "twilight state".
These surgeries improve the ocular surface. This is critical to optimizing vision, comfort and the appearance of the eye. Patients who are considering both lens and laser based vision correction will find that the procedures work better in the absence of a pterygium.
