Pterygium and Pingueculum

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This is a non-malignant growth which grows from the white “skin” (conjunctiva) on the front of the eye onto the clear “window” (cornea) which is in front of the coloured part of the eye. Pterygium usually occurs in the inside corner of the eye.

Pterygium usually happens after many years of exposure to sun, dust, wind etc. Ultraviolet light is a big factor in causing pterygium (this will get worse with the hole in our ozone layer). Having an injury or severe infection in the eye can seem to start off a pterygium. Patients who have a small pterygium or who have had pterygium surgery should always wear glasses with UV filter when they go outside.

POTENTIAL PROBLEMS CAUSED BY PTERYGIUM

1. APPEARANCE. They can look terrible and make the eye constantly red.
2. IRRITATION/REDNESS. Even when small it can be quite irritating on, say, hot windy days or in a smoky or dusty environment.
3. VISUAL DISTORTION (or the threat of this) - especially when it is quite large.

TREATMENT

Drops temporarily help the appearance and the irritation. Lubricants such as GenTeal Gel or Refresh Tears Plus may help. Use “over-the-counter” eye whiteners (like Naphcon A) as little as possible. If these are inadequate then using weak cortisone drops (prescription only) can help and are safe if used only for a few days every now and then. Steroid drops are NOT a long-term option, and if they are often required you should consider surgery.

SURGERY

Most cases of pterygium bad enough to bring to a specialist’s attention end up requiring operation. The procedure takes about 45 minutes, and requires a hospital day stay and the use of the operating microscope. Local anaesthetic is used, and the procedure is considered by nearly all patients to be no worse than, say, a dental procedure.

After the procedure you will need to use drops for about 6 weeks and attend the office 2-3 times during this time.

It takes about 6 weeks for the eye to settle after pterygium surgery and most patients want to be off work for 4-5 days, as the eye may be quite sore early on. The spectacle prescription can sometimes change slightly as a result of pterygium surgery.

RECURRENCE

Over half of operated pterygia will tend to grow back after simple surgical removal. A technique to lower this recurrence rate to about 5% is Conjunctival Autograft (see below). When the pterygium is removed, we transplant some normal conjunctiva (the transparent “skin” of the white of the eye) that has been unaffected by UV light (eg the conjunctiva that is normally behind the top lid) onto the surgical area. This normal conjunctiva usually heals normally and does not have the tendency to cause or be associated with a recurrence of pterygium.

(a) Pterygium
(b) Pterygium removed,
(c) leaving bare area
(d) Graft outlined
(e) Graft sutured into place

Other techniques to lower recurrence rate (eg mitomycin applications or radiation) may be used in particularly difficult situations, but are not the first choice as they have the possibility to cause severe problems longer-term.

POST-OP INSTRUCTIONS (AFTER SURGERY)

1. Your eye may be very sore for 3-4 days - it may be necessary to take some pain-killers (Panadeine, Nurofen) and a sleeping tablet in the first day or so. Ice packs (frozen peas) give good relief from the soreness in the first day or two.
2. The sutures on the surface of the eye will feel a bit scratchy initially, but this tends to settle down over a day or two.
3. Your eye will be sensitive to light for about one week. Wear sunglasses to protect your eye from glare.
4. Use the eyedrops and ointment as directed by your doctor. The Prednefrin forte is an anti-inflammatory drop and helps to prevent recurrence of the pterygium. It is used on a decreasing dosage regime for about 6 weeks. The Chlorsig ointment protects against infection and also is quite soothing. Once the eye feels quite comfortable it is OK to cease the ointment.
5. DO NOT DRIVE while wearing the eye patch.
6. BE CAREFUL with steps and crossing roads while wearing the eye patch.
7. If you are concerned about your eye after the operation, please ring the office Monday to Friday, contact your surgeon on the after hours numbers provided at the time of surgery, or attend the Emergency Department of the Royal Victorian Eye and Ear Hospital (9929 8666).

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