Pterygium

👁️ Pterygium

🔍 Definition

A pterygium is a triangular or wedge-shaped fibrovascular growth of conjunctival tissue that extends onto the cornea, usually from the nasal side.

It is often associated with:

• Chronic UV exposure

• Dry, dusty, or windy environments

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🌍 Epidemiology

Feature	Notes
Common in	Tropical/subtropical regions
Risk factors	UV light, outdoor work, wind, dust
Age group	Adults >20 years (but can occur earlier)
Gender	Slight male predominance

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⚙️ Pathophysiology

• UV radiation → chronic irritation → degeneration of collagen and proliferation of fibrovascular tissue

• Starts at the limbus and gradually invades the cornea

• Can alter the corneal curvature → astigmatism

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👀 Clinical Features

Symptom/Sign	Description
Triangular growth	From nasal conjunctiva toward cornea
Irritation / redness	Especially with exposure to wind or sunlight
Dryness / foreign body sensation	Due to ocular surface changes
Tearing	Reflex lacrimation from irritation
Blurred vision	If pterygium encroaches on the visual axis or causes astigmatism
Stocker’s line	Iron deposition line seen at head of pterygium (optional finding)

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🔬 Grading

Grade	Description
Grade 1	Reaches limbus only
Grade 2	Between limbus and pupil margin
Grade 3	Reaches up to or over pupil

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🧪 Differential Diagnosis

• Pinguecula – yellowish conjunctival lesion not crossing the limbus

• Conjunctival intraepithelial neoplasia

• Limbal dermoid (in children)

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🧑‍⚕️ Treatment

🔹 Conservative (for mild cases):

• Lubricating eye drops

• Sunglasses / UV protection

• Topical NSAIDs or mild steroids for inflammation

🔹 Surgical (for progressive or vision-threatening cases):

• Indications:

  • Vision obstruction

  • Astigmatism

  • Cosmetic concern

  • Recurrent inflammation

Common Techniques:

1. Bare sclera excision (high recurrence)

2. Conjunctival autograft – ↓ recurrence

3. Amniotic membrane graft

4. Adjunctive therapies:

   • Mitomycin-C (to reduce recurrence)

   • Beta irradiation (rarely used now)

⚠️ Recurrence is common, especially if bare sclera technique is used without graft.

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⚠️ Complications

• Recurrence – can be more aggressive than the original

• Corneal scarring

• Astigmatism

• Infection or graft failure (post-surgery)

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📋 Summary Table

Feature	Pterygium
Appearance	Triangular, fleshy, vascularized growth
Common location	Nasal side of eye (medial)
Cause	UV, dust, wind, chronic irritation
Symptoms	Irritation, redness, tearing, visual blur
Complication	Astigmatism, visual axis obstruction
Treatment	Lubricants ± surgical removal if needed
Prevention	Sunglasses, hats, artificial tears

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🧠 Mnemonic – “PTERYG-IUM”

• P – Progressive

• T – Triangular

• E – Extends to cornea

• R – Redness & irritation

• Y – Yellow-white appearance

• G – Grows nasally (usually)

• I – Induces astigmatism

• U – UV exposure is key risk

• M – May need surgery

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Would you like:

• A comparison chart between Pterygium & Pinguecula?

• A diagram of the lesion?

• Or surgical steps summarized for study?

Let me know how you’d like to proceed!