PTERYGIUM

Dr RAHUL K. JANGID
INTRODUCTION
• Pterygium, from the Greek pterygos meaning “wing”, is a
common ocular surface lesion originating in the limbal
conjunctiva within the palpebral fissure with progressive
involvement of the cornea.
• The lesion occurs more frequently at the nasal limbus than the
temporal with a characteristic wing-like appearance.
ETIOLOGY
• The etiology is unknown.
• An increased incidence is noted in latitudes nearer the
equator and in individuals with a history of increased UV
exposure.
• Usually in old age.
• Slightly higher incidence in males than females, which may
only reflect a higher rate of UV radiation.
• Unilateral or Bilateral
• Nasal > Temporal
RISK FACTORS
• UV radiation
• Proximity to the equator
• Dry climates
• Dust exposure
• Outdoor lifestyle.
HISTOLOGY
• Histologically, pterygia are an accumulation of degenerated
subepithelial tissue which is basophilic appearance on H&E
staining.
• Elastotic degeneration refers to the wavy worm-like
appearance of the fibers.
• Destruction of Bowman layer by fibrovascular ingrowth is
typical.
• Overlying epithelium is usually normal
• May show acanthotic, hyperkeratotic
even dysplastic and often exhibits
areas of goblet cell hyperplasia.
PATHOPHYSIOLOGY
• Most accepted Theory is increased prevalence in hot dry
climates and regions nearer to the equator suggest a role of
environmental factors such as UV radiation and dryness.
• Actinic changes seen on histopathology similar to actinic
keratoses on the skin also supports the role of UV radiation.
• It has been suggested that radiation activated fibroblasts may
result in elastotic degeneration excessive production of
material resulting in pterygia.
• Other proposed theories include choline deficiency,
inflammation, immune system abnormalities, tear film
abnormalities, as well as the possible role of a viral stimulus.
CLINICAL FEATURES
SYMPTOMS-
• Cosmetic intolerance early stages
• Irritation
• Foreign body sensation
• Defective vision d/t Corneal astigmatism in later stages
• Diplopia d/t limitation of ocular movements
SIGNS-
• Triangular fold of conjunctiva usually nasal side may occur on
temporal side.
• Rarely primary double pterygium.
CLINICAL FEATURES
• Fuchs' Patches- Minute gray blemishes that disperse near the
pterygium head
• Stocker's Line -A brownish line composed of iron deposits
• Hood fibrous nonvascular portion of the pterygium
• Head apex of the pterygium, raised and highly vascular
• Body fleshy elevated portion congested with tortuous vessels
TYPES
• PROGRESSIVE PTERYGIUM thick fleshy vascular with FUCH’S
spots or Islet of Vogt or cap of perygium
• REGRESSIVE PTERYGIUM thin atrophic with little vascularity
with STOCKERS line. Later becomes membranous but never
disappears.
D/D
PSEUDOPTERYGIUM
• Non progressive Fold of bulbar conjunctiva attached to cornea
• Due to adhesion of chemosed bulbar conjunctiva to the
marginal corneal ulcer
• Occurs following chemical burns of eye
• Probe test positive- probe can be passed below the neck.
COMPLICATION
• Loss of vision
• Cystic degeneration
• Infection
• Neoplastic changes
• Epithelioma
• Fibrosarcoma
• Malignant melanoma
MANAGEMENT
PREVENTION-
• As it is associated with excessive sun or wind exposure,
wearing protective sunglasses with side shields
• Wide brimmed hats and using artificial tears throughout the
day may help prevent their formation or stop further growth.
TREATMENT-
• Pterygium typically do not require surgery unless it grows to
such an extent that it causes visual problems.
• Symptoms such as irritation can be addressed with artificial
tears Lubricating eye drops.
• Surgery may also be considered for unmanageable symptoms.
MANAGEMENT
SURGICAL EXCISION-
INDICATION
• Cosmetic problems
• Visual impairment is significant
• Progressive pterygium encroaching the pupillary area
• Diplopia
Surgical excision-
• Topical anesthesia
• Head of pterygium lifted and dissected over cornea
meticulously.
• Body dissected from underneath sclera and superficial
conjunctiva.
• Excision of pterygium
• Hemostasis by cautrization
• Bare sclera technique
• P & b done with antibiotic oint
Recurrence of pterygium-
• After surgical excision main problem is recurrence of
pterygium which is fast growing and vascularised.
• It can be reduced by following means-
• Surgical excision with Free Conjunctival limbal autograft with
suture.
Recurrence of pterygium-
• Surgical excision with Amniotic Membrane Graft and 0.02%
Mitomicin-C-done with large pterygium and recurrent
pterygium

• Surgical excision with Lamellar Keratectomy and Lamellar

Keratoplasty in deep infiltrating recurrent pterygia

• Radiotherapy has also been used in an attempt to reduce the

risk of recurrence.
COMPLICATIONS
• Recurrence
• Corneal scarring
• Corneal perforation
• Strabismus
• Non-healing epithelial defect (esp with mitomycin C)
• Scleral melt (esp with mitomycin C)
D/D
PSEUDOPTERYGIUM
• Non progressive Fold of bulbar conjunctiva attached to cornea
• Due to adhesion of chemosed bulbar conjunctiva to the
marginal corneal ulcer
• Occurs following chemical burns of eye
• Probe test positive- probe can be passed below the neck.
D/D
PINGUECULA
• Pinguis means fat like
• Common degenerative condition of conjunctiva
• Yellowish white patch near the limbus
• Bilateral triangular patch
• Nasal to start then involve temporal side also
• Topical steroid if cosmetically unaccepted then excision
• Calcification may present
Thank you..

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