A pterygium is a growth of thickened tissue that starts in the white part of the eye, and grows over the clear cornea. As it grows, it eats away the surface of the cornea like an open-cut mine.  This results in permanent corneal scarring, with a permanent reduction in vision.  The most common cause is UV light exposure.   Pterygium is not a cancer, and tends to grow very slowly.

 

Pterygium is a potentially blinding disease, with four clinical phases.

1.  Cosmetic phase

2.  Irritation phase

3.  Visual reduction phase

4.  Blindness phase.

 

The reasons for surgery are:

1. Reduced vision

2. Distortion of the cornea, called astigmatism.

3.    Documented Growth

4.    Size greater than 3 mm.

5.    Irritation, watering or discomfort

6.    Cosmetic appearance

 

The operation usually takes less than 10 minutesm, with local anaesthetic and sedation as day-only surgery.  Whilst this sounds scary, we have never had a patient require general anaesthetic with the modern techniques.  

 

We remove the pterygium by cutting across the base of it, and carefully scraping it off the surface of the eye with a diamond-dusted burr.  This is important to minimize the scarring on the surface of the eye.  We then take a small graft of conjunctiva from under the upper lid, and glue this where the pterygium was growing.  This gives a low recurrence rate of less than 3%. By using glue, very few stitches are required, and the eye is much less painful.

 

Risks of Surgery

All surgery around the eye has risks.  The most common event is recurrence of the pterygium, in less than 3% of patients.  Other than persistent redness and recurrence, complications are very rare, and include infection and bleeding.  Pterygium always causes scarring in the cornea underneath, and this can limit the vision by persistent astigmatism.  Healing of the eye can also occur in an exaggerated lumpy way (“granuloma”) similar to keloid scars of the skin.  If pterygium recurs, the surgery will need to be repeated, sometimes with the addition of Mitomycin to reduce the risk of regrowth.  

 

Do you need surgery?

Patients vary widely on the size of pterygium they are able to tolerate.  Some patients are not bothered by very large red pterygium.  Others find the smallest of lumps very annoying.

 

If your vision is normal, and the pterygium is small, then it really is your choice whether you wish something done.  Are you bothered by it?  Pterygium usually doesn’t change fast.  If you chose not to have surgery, then you should be checked every six months.  If yours is growing, then it is worth considering surgery.  Eye irritation can be caused by other pathology, and it is important to exclude these before considering surgery.   Once vision is lost to pterygium, it is not always regained with subsequent surgery.  Whilst progression is usually slow, it is typically relentless over time.

 

Post-op recovery

There are three phases to healing.  

The first phase is the first few days after surgery, as the corneal ulcer heals.  The eye will be sore, and you will need oral pain relief.  It is common for you to “feel something scratchy” is in the eye.  You should not drive during the first few days, especially if you are taking pain-killers.  You will have two bottles of drops to use 4 times a day.  Avoid getting your eye wet, and do not swim for one month.  

 

The second phase is the graft becoming incorporated into the surrounding tissue, which takes several weeks.  The third phase is the completion of healing, which takes several months for the redness to settle down.  Some patients always have persistent redness where the pterygium was, if the eye heals with prominent blood vessels.  This is much less common now, with the use of the glue.

 

The reason for surgery is primarily to prevent loss of vision.  Usually the vision improves or stays the same after pterygium surgery, but usually the glasses need to be updated as your eye focus almost always changes.  Sometimes the vision gets worse due to scarring from the pterygium.