Pterygium

What is a pterygium?

A pterygium (pronounced ter-ij-ee-um)  is a raised, triangular or wedge-shaped, benign growth of conjunctiva tissue. The conjunctiva is the mucus membrane that covers the front of your eye. It usually occurs on the side of your eye nearest your nose.

What causes a pterygium?

A pterygium usually develops if you have been living in a hot, dry climate. This may be a response to:

  • your eye’s long-term exposure to sunlight and
  • chronic eye irritation from the dry climate It is most often occurs in people

who have lived in a hot dusty country or have worked outdoors for many years. It may be due to drying of the eye.

How does a pterygium affect the eye?

In the early stages the eye may feel uncomfortable and look slightly red but vision is unaffected.

Main symptoms include:

  • irritation
  • redness
  • tearing (eyes watering).

As the pterygium develops it may alter the shape of the cornea, making it curve more. This causes astigmatism, which affects how your eye focuses. When the pterygium has grown towards the centre of your cornea it will affect your vision.

How is it diagnosed?

it is possible to see the pterygium, just by looking at your eye.

How can it be treated?

Treatment depends on the symptoms.

If the pterygium is small and not causing symptoms then no treatment is needed or you may be prescribed eye drops or ointments to relieve any redness or irritation.

If the pterygium is growing or becomes troublesome it may be necessary to proceed to surgery.

For example, when:

  • it is causing constant eye irritation
  • it is causing problems with your vision
  • you are unhappy with how it affects your appearance.

What happens if I do not get treatment?

It is unlikely that the pterygium will get worse if you are living in the UK. If you are planning to move to a hotter, drier climate then it could get worse. Surgery is the only way to remove the pterygium.

What are the benefits of surgery?

In most cases a pterygium comes away very cleanly and heals well, leaving only faint scarring on the cornea and with the white of the eye slowly returning to a normal appearance. Your symptoms, such as eye irritation will reduce, the appearance of your eye should improve. and in cases where the pterygium has affected vision by inducing astigmatism, restoration of a more normal surface reduces astigmatism and improves vision.

What are the risks?

Recurrence – The main risk is that the pterygium will regrow. It may come back (within a year) in up to 50% of cases without an autograft and 5-10% with an autograft. If it does come back it may be more aggressive and progressive than before surgery. Surgery can be repeated, but with lower success rates.

Pain – this should settle within a few days with painkillers, but please contact us if it is getting worse despite regular medication.

Redness – The eye may look redder for a few days after surgery but will gradually improve with time.

Side effects from drops – Occasionally an allergy develops due to the drops or a pressure problem in the eye. The clinic doctor will check for these problems.

Dryness – The eye may still not have a perfectly smooth surface after surgery and lubricating drops may still be required.

Scarring – Scarring of the eye surface and eye muscles can occasionally cause restricted movement of the eye and double vision. Further treatment would probably help.

Infection – There is a risk of infection, but this can be treated.

What does the surgery involve?

Because the operation only involves the outer layers of the eye, pterygium surgery is relatively safe compared to many types of eye surgery.
The operation  is performed using a local anaesthetic which numbs the eye so that you feel no discomfort.
You do not need to do anything to prepare – just make sure that you have had a light meal and wear comfortable clothing.

The operation involves carefully removing the conjunctival tissue over the cornea. To try and prevent the pterygium regrowing, it is often combined with the grafting of a free flap of adjacent conjunctiva (usually taken from under the upper eyelid) to the bare area of the white of the eye (sclera). This new graft is held in place with tissue glue so there are no stitches.

The eye will then be covered with a pad which you will need to leave in place for 24 hours.

What happens after the operation?

You will be offered a drink before you leave. You will be given antibiotic and steroid eye drops drops to use in the eye once the dressing is removed. These drops need to be continued for several weeks. Do not stop the drops until we tell you to.

The eye may feel quite sore for about three to seven days and be red for about six to 12 weeks, but this will gradually settle. You can to take tablets for pain relief regularly.

If you usually wear contact lenses,  we will tell you when you can start to wear them again.

You may need several follow up visits to clinic. The first one will be arranged before you leave hospital. You may need at least a week off work.

For 48 hours after the surgery, please do not:

  • drive any vehicle, including a bicycle
  • operate any machinery
  • attempt to cook, use sharp utensils or pour hot or boiling liquids
  • drink alcohol
  • smoke
  • take sleeping tablets
  • make any important decisions or sign any contracts.

Will I have any follow-up appointments?

You will need to come back into hospital the day after your operation so we can check on your recovery and remove the pad covering your eye. You will then be given an appointment for one month after your surgery and another for three months after surgery.

Is there anything I need to look out for at home?

Occasionally you could get an infection in the eye. This will cause redness and pain. If this happens you should call the eye department.

When can I resume my normal activities?

You should be able to go back to work within a few days, as long as you feel well enough. You can bathe or shower as normal, but you should avoid swimming for two weeks. This is because of a risk of infection.