Pinguecula - A Review

Introduction

Pinguecula is an eye condition that is seen as a yellow lesion that appears a little raised on the conjunctiva. They are generally harmless and have more cosmetic concerns in patients. However, in some affected individuals, it causes severe discomfort and disturbances in sight. This article intends to explore this ocular condition, its causes, clinical features, diagnosis, and available treatment modalities.

What Is Pinguecula?

Pinguecula is a common condition affecting a portion of the eye. It most commonly affects the membrane covering the sclera. It can affect one eye or both eyes simultaneously. They are generally made of degenerative tissues and are often associated with exposure to ultraviolet light, wind, dust, and other irritants. The name of this condition originates from Latin, wherein “pinguis” means fat.

What Are the Causes of Pinguecula?

The exact cause is unknown. However, many contributing factors are considered to have a role in the development of Pinguecula:

• Irritants: The irritants present in the environment, such as wind, particles in the air, pollutants, pollens, and dust, may contribute to the development. These can exacerbate the inflammation and degeneration in the eye membrane.

• Genetic: Genetics may play an important role in developing Pinguecula. Genetic polymorphisms may also potentiate the susceptibility of forming Pinguecula in response to other irritants.

• Chronic Exposure to Ultraviolet Light: Ultraviolet light exposure for a long time induces oxidative stress and inflammatory changes in the eye membrane. All these lead to degeneration and may proceed to develop Pinguecula.

• Increased Age: An increased prevalence is seen in the higher age group, with an average of around 40 years. It has been seen that almost all individuals show some Pinguecula signs in their 80s. This can also be attributed to age-related degenerative changes.

• Contact Lens: This increased risk seen in lens wearers may be implicated in constant friction by the edge of the lens. This also leads to inflammatory changes, thereby leading to the formation of Pinguecula.

• Gaucher Disease: Certain Pinguecula are triangular and brown-pigmented. Study reveals such lesions present with a histological picture of lipid-laden macrophages, which is suggestive of Gaucher disease.

• Dry Eye Syndrome: Individuals with dry eyes often have a higher chance of Pinguecula in their membranes. The reason for this is chronic dryness leads to inflammatory and degenerative changes.

What Are the Clinical Features?

Pinguecula is a benign lesion that appears yellow and has a raised elevation seen on the conjunctiva, the thin, transparent membrane covering the white part of the eye. Most of the cases are painless and associated with no other symptoms. However, in certain individuals, it is seen as:

• Redness: At certain times, the Pinguecula gets inflamed and appears red and swollen, more commonly seen as a response to environmental triggers. When it gets inflamed, it is known as Pingueculitis. During this process, there is an increased risk of histamine, serotonin, and prostaglandins.

• Vision Disturbances: Generally, Pinguecula does not affect visual acuity. However, at certain times, it encroaches on the cornea, leading to mild vision blurring.

• Cosmetic Concerns: The yellow or brown appearance or enlarged large-sized lesion is a cause of great esthetic concern for some individuals and might be indicated for surgery in such cases.

• Dry Eyes Symptoms: Burning, itching, and foreign body sensation might be present.

How Is It Diagnosed?

An ophthalmologist must perform a complete eye examination and evaluation. Laboratory tests are not required.

• Clinical Examination: A thorough and complete history is to be taken to assess when it started and if accompanied by any symptoms and disturbances in sight.

• Visual Acuity Test: This is an eye test to check vision using a chart to read letters and symbols in various sizes.

• Slit Lamp Examination: This is a microscopical examination to evaluate in detail the Pinguecula, its size, shape, and exact location.

Differential Diagnosis:

• Pterygium: Fleshy growth into the cornea.

• Nevus: Pigmented lesion.

• Lymphoma of the Conjunctiva: Very rare malignancy of the eye membrane.

What Are the Treatment Options?

As such, treatment for Pinguecula is not required. Certain protective measures, symptomatic relief measures,

• Protection: The clinician must advise the patients to protect the affected eyes from all kinds of irritants with the help of sunglasses and hats. A visor can considerably reduce ultraviolet light exposure to the eye. Polarized lenses also help reduce exposure further.

• Artificial Tears: In patients with signs of dry eyes, these drops can reduce the dryness, discomfort, and burning associated with it.

• Anti-inflammatory Medication: Topical steroid eye drops may be prescribed in the short term to reduce inflammation. Care must be taken not to use this indiscriminately to avoid the risk of side effects. Non-steroidal anti-inflammatory medications may also be prescribed as an alternative to manage the pain, swelling, and inflammation.

• Surgical Excision: It is to be performed for cosmetic reasons. It is conducted under local anesthesia. In severe cases, after surgical removal, it might need autografting. The excised tissue must be sent for histological evaluation to rule out malignancies.

• Argon Laser Photocoagulation: This method can be considered a safe alternative to surgical excision. This method has reduced complications as there is more control over the extent of tissue removal.

How Can This Be Prevented?

• Ocular Hygiene: Regular washing and cleaning is important to keep the eyes clean. Avoid any form of rubbing and scratching the eyes.

• Irritants: Care must be taken to protect the eyes from all irritants and ultraviolet light.

• Regular Eye Examination: Individuals are advised to undergo routine eye examinations to diagnose and intervene early if required. This helps in preventing complications and corneal encroachment.

By implementing these strategies, an individual can reduce Pinguecula development and relieve its symptoms.

Conclusion

To conclude, Pinguecula is a common and generally harmless eye condition. It is seen as a yellow-white raised lesion on the conjunctival membrane. Typically asymptomatic and does not affect vision, it raises cosmetic concerns, especially when the size is large. Most of the cases can be treated with a conservative approach; surgical excision or laser photocoagulation is advocated in cases where the other methods do not work and there is a significant esthetic concern.