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Surgical Management of Pterygium - An Overview

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Pterygium is a growth in the white part of the eye that causes a disturbance in vision. Read the article to know about its surgical management.

Medically reviewed by

Dr. Asha Juliet Barboza

Published At January 9, 2023
Reviewed AtJune 10, 2024

Introduction

Pterygium is a fleshy, triangular-shaped overgrowth present on the conjunctiva of the eye. Conjunctiva is the transparent membrane that covers the white portion of the eye. It gets affected by prolonged exposure to ultraviolet light. It is not cancerous and usually does not cause severe symptoms leading to loss of vision. Most individuals affected by pterygium do not require any treatment unless the overgrowth causes an interference in the vision.

What Is Pterygium?

Pterygium is derived from the Greek word ‘Pteryx,’ meaning ‘wing,’ and ‘Pterygion,’ meaning ‘fin.’ It is a wing-shaped structure on the conjunctival tissue. It grows gradually and sometimes might grow large enough to cover the pupil, which is the black portion of the eye. When it affects both eyes simultaneously, it is called a bilateral pterygium. The pterygium will remain in the eyes throughout, growing slowly or stopping to grow suddenly.

What Are the Causes of Pterygium?

Pterygium is caused mainly by a long period of exposure to the sun’s ultraviolet rays. Anyone who spends more time under the sunlight can develop the condition. It can also occur when the eye is exposed to dust, wind, pollen, and hot and dry weather. It is a rare disease affecting only 12 % of the world’s population. Of the people affected, it is most commonly seen in older patients above 80 years of age.

What Are the Signs and Symptoms of Pterygium?

The pterygium might show no symptoms in a few individuals. If symptoms develop, they may be mild or severe.

  • A fleshy pink growth in the eye.

  • Itchiness or irritation within the eyes due to dryness.

  • Redness and swelling of the eye.

  • Feeling of sand or dirt within the eye.

  • Inability to wear contact lenses.

  • Teary eyes.

  • A bulgy appearance of the eye due to overgrowth.

  • The vision gets interfered causing blurred or double vision.

How to Diagnose a Pterygium?

The following are the tests done by an ophthalmologist to examine and confirm the diagnosis of the growth in the eye.

  • Slit Lamp Examination: A microscope with a bright light is used to examine the structures around the eyes in detail. This allows the doctor to detect the involvement of the overgrowth and any damage caused to the adjacent structures.

  • Photo Documentation: Photographs of the eye with the growth are taken to check the progress and the rate at which it grows.

  • Visual Acuity Test: It is a routine eye examination where the individual is checked for distant and near vision by reading out the letters being displayed at a required distance.

  • Corneal Topography: A detailed examination of the cornea providing information about the shape, power, and condition of the corneal surface. It creates a three-dimensional display of the corneal image on the computer screen.

What Is the Treatment for Pterygium?

The treatment for pterygium is started initially with a symptomatic treatment wherein the doctor prescribes eye drops to reduce the redness. The treatment limited to medications alone is in cases where pterygium is less than three millimeters in size and not involving the pupil or disturbing the vision. The main cause of pterygium forming is exposure to ultraviolet rays from the sunlight. Hence, the patient is advised to wear sunglasses while stepping outdoors to shield the eye against ultraviolet rays. Surgical management is required when the growth is about three millimeters or above. The surgical intervention is indicated in the following situations:

  • When there is severe irritation to the eyes, causing redness and a burning sensation.

  • If the patient complains of astigmatism (blurred vision) for distant and near objects.

  • If the growth keeps increasing in size and spreads across the pupil.

  • If the growth is large and causes an aesthetic appearance to the eyes, surgery is performed to remove the overgrowth and improve the cosmetic appearance.

It is up to the decision of the doctor to determine whether the patient must undergo surgery or can be treated with medications alone. A detailed eye examination provides the necessary information regarding the overgrowth, and an appropriate treatment protocol is planned accordingly.

How Does Surgical Intervention Manage Pterygium?

No particular surgery is universally accepted as a standard surgery for pterygium. Different techniques are available, which are used according to the patient’s condition. The basic aim for all surgeries is the excision (complete surgical removal) of pterygium. The surgery is completed in 30 to 45 minutes. The doctor administers local anesthesia to the eye to cause numbness and for a painless procedure. The area around the eye is cleaned with an antiseptic solution to reduce the risk of infection. The surgeon carefully removes the pterygium along with the conjunctival tissue. After the complete removal of the pterygium, a graft is placed on the operation site to prevent its recurrence. The various surgical techniques that are employed are:

  • Bare Sclera Technique: The pterygium is removed surgically without replacing the site with a graft. The white portion of the eye under the pterygium is allowed to heal on its own. This technique is associated with a high risk of recurrence.

  • Conjunctival Autograft Technique: Here, a large excision of the pterygium is performed, and a large graft is placed over it. The surgeon takes an autograft (graft obtained from the same individual) of the conjunctiva and places it over the exposed area following the pterygium removal. This technique has less frequency in causing a recurrence.

  • Amniotic Membrane Grafting: An amniotic membrane is obtained from the placenta that develops during pregnancy. It can be used as a graft which is placed over the exposed area of the eye after surgery. A fibrin glue can be used to attach the membrane to the underlying tissues. This technique also prevents recurrence.

For the prevention of recurrences and complete healing of the eyes, a few adjunctive therapies are helpful. They include using Mitomycin C (a chemotherapeutic agent) or MMC, which can be used directly on the eyes after the surgical excision or postoperatively as eye drops. The doctor covers the eye with an eyepatch, and the patient is advised not to touch or rub the operated eye. Complete recovery occurs in a few weeks to months depending on the patient’s condition. The surgical removal of the pterygium, placing a graft over it, and using eye drops helps to provide complete healing and has reduced the recurrence rate.

What Are the Complications After Pterygium Surgery?

  • The most common complication is the regrowth of pterygium, which can be prevented by placing a graft.

  • Graft edema (swelling of the graft tissue).

  • Graft necrosis (death of the graft tissue).

  • Scar formation at the cornea.

  • Infection.

Conclusion

Pterygium is an overgrowth that occurs in the eye and causes irritation and discomfort. The surgical treatment is only indicated under specific circumstances with severe irritation and growth above three millimeters. The surgical procedure is minimally invasive, causing less discomfort postoperatively, but the recurrence rate is one of the important factors to consider. The use of grafts and MMC eyedrops has reduced the recurrence rate considerably. A regular follow-up with the doctor to check the treatment progress is done to obtain a successful recovery.

Frequently Asked Questions

1.

Which Treatment Is Best for Pterygium?

Retrobulbar anesthesia is best because it offers adequate levels of pain control during the surgery. It is often the most comfortable option for the patient. When peeling off the pterygium eye's surface, a person should be careful not to harm the underlying corneal tissue or remove stroma.

2.

What Is Pterygium Eye Surgery?

The sclera and cornea of the eye must be cleaned of any aberrant tissue during pterygium surgery. The success rate of modern surgical methods is much higher than traditional surgeries. Traditional "bare sclera" pterygium excision exposes the underside of the eye's white.

3.

How to Perform Eye Surgery for Pterygium?

The lesion must be removed from the eye's surface during pterygium surgery. The area where the pterygium was removed is then filled with a little piece of skin cut from beneath the eyelid. Utilizing self-transplant aid in pterygium prevention as well is necessary.

4.

Is Surgery Required for Pterygium?

If eye drops or ointments do not relieve the pterygium, a doctor may advise surgery to remove it. Surgery is often performed when a pterygium results in vision loss or astigmatism, a condition that can cause hazy vision.

5.

What Are the Indications of Pterygium Surgery?

The primary reason for pterygium surgery is visual impairment brought on by the invasion of the pupillary region or astigmatism that has been artificially created. Other indications to consider include restricted eye mobility, persistent redness, a feeling of a foreign body in the eye, and aesthetic issues.

6.

Is Laser Required for Pterygium Surgery?

The pterygium is removed during the treatment with the help of a laser, and the surgeon takes a graft from another area of your eye to patch the wound with your secure tissue. The whole process just requires 30 to 45 minutes.

7.

What Are the Risks of Pterygium Surgery?

Subconjunctival bleeding, graft edema (the swelling of tissue in a transplanted organ or tissue graft due to fluid accumulation), graft loss, retraction, graft sliding, granuloma (a small, localized area of inflammation in tissue, often characterized by immune cells clustering together), and recurrence are the side effects of pterygium excision and auto-grafting. Corneal perforation and melting are less frequent.

8.

How Is Pterygium Treated Without Surgery?

Pterygiums can be treated without having them surgically removed. Smaller growths are typically treated with moderate steroid eye drops to reduce redness and swelling or artificial tears to lubricate the eyes.

9.

Can Pterygium Surgery Cause Pain?

The pterygium is removed during surgery, and it is replaced with a tissue transplant that is bonded in its place. The process is entirely painless, and there are no stitches.

10.

What to Expect After Pterygium Surgery?

Patients may feel moderate itchiness, impaired vision, and eye redness during the healing process. Within the first few days, patients can resume typical activities like driving, working, and attending school. Complete recovery can take several weeks to a month.

11.

How to Assess the Success of Pterygium Surgery?

With only slight to moderate discomfort, healing takes two to four weeks to complete. However, the high regrowth rate following "bare sclera" pterygium surgery is regrettable; it affects up to 50 % of patients. In addition, the pterygium frequently recurs at a bigger size than before.

12.

Will Pterygium Recur After Surgery?

Sadly, a pterygium frequently grows again after being surgically removed. (If a person is under 40, this might be more likely). Sometimes the regrowth produces symptoms that are more severe than the initial one.

13.

What Precautions Are Taken After Pterygium Surgery?

Avoid rubbing, pressing, or bumping the operated eye. Instead, use a saline solution to dampen a cotton ball and wipe away crusting from lashes. For two weeks following surgery, refrain from using mascara or eye makeup. Avoid rinsing the eyes.

14.

What Type of Eye Drops Are Good for Pterygium?

If the eye is especially inflamed and swollen, steroid eye drops may be administered. If the pterygium has started to impair vision, surgery to remove it may be possible.

15.

How to Diagnose Pterygium?

The eye doctor can identify pinguecula and pterygium during a slit-lamp examination. First, the structures around the eyes are examined with bright light under a microscope, enabling the physician to determine if the overgrowth's involvement and harm are done to the nearby structures. Next, precancerous growths must be excised and studied under a microscope.
Dr. Asha Juliet Barboza
Dr. Asha Juliet Barboza

Ophthalmology (Eye Care)

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