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Pterygium |
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Definition
of Pterygium |
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The conjunctiva
lines the inside of the lids and covers
the sclera (white part of eye). The cornea
lies in front of the colored part of the
eye (iris). A pterygium (from the Greek
word pterygion for wing) is a slightly elevated,
superficial, wing-shaped, fleshy conjunctival
growth that covers and alters the shape
of the cornea. It may be yellow, gray, white,
pink, red, or even colorless. It may have
blood vessels. Pterygium may be small or
grow large enough to interfere with vision.
Most patients with pterygium contact ophthalmologists
either due to concern regarding the appearance
of the lesion, or because the lesion is
irritating the eye or it is adversely affecting
vision.
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Pterygium |
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Typically, the pterygium
is first noticed on the conjunctiva, and
then is noted to gradually grow onto the
cornea of the eye. When the growth is confined
to the conjunctiva, it is known as a pingueculum.
When it extends onto the cornea it is called
a pterygium. Left alone, some pterygia will
eventually grow to obscure the optical center
of the cornea, thereby obstructing vision.
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Facts
about Pterygium |
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A pingueculum may
develop into a pterygium.
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Commonly found in
individuals who spend a lot of time
in the sun or live in dry, windy, smoky,
dusty, sandy tropical climates.
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Reported to occur
in males twice as frequently as in females.
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Almost always confined
to the exposed surface of the conjunctiva,
and usually on the side closest to the
nose. Less often, it can also occur
on the outer side of the cornea.
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One or both eyes
may be involved.
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Some pterygia grow
slowly throughout a person's life, while
others stop growing after a certain
point.
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Pterygium is alteration
of normal tissue resulting in a deposit
of protein and fat.
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Not dangerous (non-malignant)
but can become uncomfortable.
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Usually a pterygium
does not lead to anything catastrophic
such as a serious loss of vision or
blindness.
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Can eventually distort
vision due to growth onto the cornea,
and eventually even onto the central
part of the eye blocking light from
entering.
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Removing a pterygium
surgically will take care of the problem.
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The rate of recurrence
is as high as 40%, and they tend to
come back bigger and faster.
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Causes
and Risk Factors of Pterygium |
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|  No
one knows what exactly causes a pterygium
to develop. It is usually known to occur
more often in people who spend a great deal
of time outdoors, especially in sunny climates.
Many doctors believe ultraviolet (UV) light
from the sun may be a factor. Sunlight,
especially ultraviolet (UV) rays, and chronic
eye irritation from hot, dry, dusty, windy
conditions seem to play an important role
in the development of pterygium. Risk factors
for pterygium include the following:
- Ultraviolet light exposure (both UV-A
and UV-B) appears to be the most significant
factor in the development of pterygium
including living in subtropical and tropical
climates. People living near the equator
are often affected. Pterygium is rare
in children.
- People who spend considerable time
in the sun (for example, farmers, fishermen,
surfers, skiers, golfers, and gardeners)
are much more likely to have pterygium
than people living mostly indoors.
- Engaging in occupations that require
exposure to ultraviolet (UV) light and
arc, for example welders.
- Other agents that may contribute to
the formation of pterygia include allergens,
noxious chemicals and irritants (e.g.,
wind, dirt, dust, air pollution).
- A genetic predisposition to the development
of pterygia appears to exist in certain
families.
- Some studies report a higher prevalence
of pterygia in men than in women, and
this may reflect different rates of exposure
to UV light.
- There is a higher rate of pterygium
in people living near the equator. In
the United States, the incidence is less
than 2%. In Florida and California, the
incidence is close to 4%. By the equator,
the incidence goes up to 20%.
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Signs
and Symptoms of Pterygium |
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- Redness
- Irritation
- Dryness
- Inflammation
- Tearing
- Foreign body sensation
- Painless area of elevated white tissue with
blood vessels on the inner and / or outer edge
of the cornea
- Growth over the central cornea can affect
vision
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Diagnosis of
Pterygium |
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The symptoms
described above may not necessarily mean that
you have pterygium, but because pterygium can
sometimes look similar to more serious eye growths,
it is important to have your eyes checked by an
eye doctor. Although some people with pterygium
constantly feel like they have a foreign body
in their eye, others are asymptomatic. In most
cases, a routine eye exam reveals pterygium in
asymptomatic individuals or in patients who present
with cosmetic concern about a tissue "growing
over the eye." People with pterygium should
be seen by an ophthalmologist annually, so that
encroachment on the pupil can be recognized and
treated before interference with vision. External
slit lamp
measurements or photography
can assist your eye doctor in following the progression
of the pterygium.
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Prevention
of Pterygium |
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 There
is nothing that has been clearly shown to
prevent a pterygium. However, because the
presence of pterygia has been linked to
exposure to UV
radiation, it is a good idea
to minimize exposure to sunlight (UV radiations)
by wearing protective eyewear with good
ultraviolet blockage, or at least hats with
brims. Consult your eye doctor about protective
coatings on sunglasses
or regular spectacles.
Protecting the eyes from sunlight, dust,
and other environmental irritants may prevent
pterygium to develop. Fortunately, most
cases of pterygium are not serious and surgery
usually is not necessary. |
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Prognosis
of Pterygium |
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Most pterygia
grow slowly and almost never cause significant
damage, so the prognosis is excellent. Again,
a diagnosis must be made to rule out other more
serious disorders. The risks of pterygium excision
surgery are low and, in general, if the pterygium
is excised before it encroaches to the center
area of the cornea, the prognosis for post-operative
vision is excellent. Pterygia often come back
after surgical removal. These recurrent-pterygia
probably have no relationship with exposure to
ultraviolet radiation.
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Treatment
of Pterygium |
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 A
conservative approach is recommended for most people.
Artificial tears can be used to relieve the sensation
of a foreign body in the eye and to protect against
dryness. When a pterygium becomes red and irritated,
topical eye-drops or ointments may be used to help
reduce the inflammation.
If you suspect you may have pterygium, be sure to
visit your eye doctor for proper treatment and a
discussion of available options for you. Evaluation
by an ophthalmologist will help determine the most
optimal treatment in each case. If a pterygium is
small but becomes intermittently inflamed, your
ophthalmologist may recommend a trial of a mild
eye drop during acute inflammatory flares. If these
drops are recommended, you should remain under the
care of your ophthalmologist to ensure that you
do not develop side effects from the use of these
medications. In some cases, your ophthalmologist
may recommend surgical removal of the tissue.
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Reasons
for Removing a Pterygium |
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Although most pterygia are harmless
and can be left alone safely; they are surgically
removed for the following reasons:
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Surgical
Removal of Pterygium |
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Surgery
is the only way to remove a pterygium, but the
results can be disappointing. Even with modern
techniques, the recurrence rate is often as high
as 30 to 40 percent and they tend to come back
bigger and faster. Surgery for excision of pterygia
usually is performed in an outpatient setting
under local or topical anesthesia with the patient
returning home the same day. Pain is uncommon.
The pterygium is carefully dissected away. Postoperatively,
the eye generally is patched overnight and healing
typically takes many weeks with patients applying
prescribed topical eye-drops or ointments several
times a day. In the early phase of healing, the
eye may be slightly swollen and bloodshot in appearance.
Eventually the surgical site improves in comfort
and appearance.
If you have any concerns about pterygium in your
eyes, schedule a free consultation with NeoVision
Eye Center at
510-431-5511 (Union
City) or 650-962-4626 (Mountain
View). |
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