Your guide to Pterygium surgery

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What is a pterygium?

Pterygium (pronounced tur IJ ee um) is a benign growth on the cornea, the clear front window of the eye, and the conjunctiva, the thin filmy membrane that covers the white part of the eye, the sclera. Pinguecula (pronounced pin GWEK yoo la) is similar, but it usually grows on the conjunctiva. They are both believed to be caused by environmental elements such as ultraviolet light, wind, and dust.

What are the symptoms?

Often, there may be no symptoms. As a pterygium grows, it may become red and irritated and cause dryness or a gritty sensation. It may also cause visual disturbances by disrupting the usually smooth surface of the cornea, and it may cause a change in glasses prescription. In severe cases, a pterygium can grow onto the central part of the cornea over the pupil and block your vision altogether.

How can it be treated?

In many cases, no treatment is needed. Lubricating eye drops can help to reduce the discomfort associated with these growths. Sometimes, you will be prescribed eye drops or ointments to reduce the inflammation should the growth become red and irritated.

If the growths become large enough to threaten sight or cause persistent discomfort, they can be removed surgically. Some people may also want them removed for cosmetic reasons. However, the growth can come back (1 in 10 chances of recurrence).

The best way to prevent pterygium and avoid recurrences is to limit your eyes’ exposure to those environmental factors that caused them in the first place, such as wind, dust or sun. The ways to do this include:
• Wear sunglasses.
• Wear eye protection in dusty conditions.
• Apply artificial tears in dry condition.

What does surgery involve?

Pterygium surgery is usually performed under local anaesthesia as a day case in the operating theatre. The eye is numbed with drops and injections, and the eyelids are held open with an eye speculum.

The pterygium is carefully removed from the cornea and the sclera (white of the eye), which generally leaves a bare patch of the sclera. A graft is taken from another site in the same eye, often from underneath the upper eyelid, and grafted to cover the exposed site.

The graft can be stuck down using blood released during surgery, fibrin glue (commonly used in eye surgery for various procedures) or absorbable sutures that fall off or are absorbed within a few weeks. The cornea is often left to heal by itself, but sometimes a soft contact lens may be placed to help heal and provide comfort. Your doctor will usually take this out during the follow up visit.

What are the possible risks of this procedure?

• Recurrence (1 in 10 cases) is usually within the first year after surgery. It may come back more aggressive than before, and surgery can be repeated, but with lower success rates.
• Infection.
• Bleeding.
• Loss of sight (<1 in 1000).

What should I expect after the surgery?

Your eye will be covered with a pad, which should be left overnight to allow the graft to set in well. Antibiotics and steroid eyedrops are prescribed for the first two to four weeks to prevent infection and help reduce inflammation. For the few days after the operation, the eye can be sore, painful, and scratchy, with the sensation that there is something in your eye, for one to two weeks. The eye will be red for the first few weeks, which generally settles by a month, though it may take up to three months in some cases. Depending on your job, you may be recommended to be off work for one to two weeks. You should consult with your doctor before resuming driving.

What if I have any problems or worries?

After the operation, it is important to contact the hospital immediately if the eye becomes sore, red, light-sensitive, or blurred vision. This could represent a rejection of the graft and requires urgent treatment.

Compiled by Ms Ritika Mukhija, MBBS, MD, FRCOphth Dr Gabriella Quiney, MBBS Mr Mayank and A. Nanavaty, MBBS, DO, FRCOphth, PhD.