Pterygium

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A pterygium is an elevated, superficial, external ocular mass that usually forms over the perilimbal conjunctiva and extends onto the corneal surface. Pterygia can develop on the nasal and/or temporal limbus and can affect either or both eyes. Pterygia can vary from small, atrophic quiescent lesions to large, aggressive, rapidly growing fibrovascular lesions that can distort the corneal topography, and, in advanced cases, they can obscure the optical center of the cornea. ^{[1, 2]}

The pathophysiology of pterygium is characterized by elastotic degeneration of collagen and fibrovascular proliferation, with an overlying covering of epithelium. Histopathology of the abnormal collagen in the area of elastotic degeneration shows basophilia with hematoxylin and eosin stain. This tissue also stains with elastic tissue stains, but it is not true elastic tissue, in that it is not digested by elastase. ^{[1, 2]}

United States

The incidence of pterygium within the United States varies with geographical location. Within the continental United States, prevalence rates vary from less than 2% above the 40th parallel to 5-15% in latitudes between 28-36°. A relationship is thought to exist between increased prevalence and elevated levels of ultraviolet light exposure in the lower latitudes. ^{[3, 4]}

International

Internationally, the relationship between decreased incidence in the upper latitudes and relatively increased incidence in lower latitudes persists.

A pterygium can cause a significant alteration in visual function in advanced cases. It can become inflamed, resulting in redness and ocular irritation.

Pterygium is reported to occur in males twice as frequently as in females.

It is uncommon for patients to present with pterygium prior to age 20 years. Patients older than 40 years have the highest prevalence of pterygia, while patients aged 20-40 years are reported to have the highest incidence of pterygium.

The visual and cosmetic prognosis following pterygium excision is good. The procedures are well tolerated by patients, and, aside from some discomfort in the first few postoperative days, most patients are able to resume full activity within 48 hours of their surgery. Those patients who develop recurrent pterygia can be retreated with repeat surgical excision and grafting, with conjunctival/limbal autografts or amniotic membrane transplants in selected patients. ^{[5, 6]}

Patients with pterygium should reduce exposure to ultraviolet light whenever possible. Methods of reducing ultraviolet exposure include wearing ultraviolet-blocking sunglasses, wearing a cap with a wide brim, and seeking shade from direct sunlight.

Patients who are at high risk of the development of pterygium because of a positive family history of pterygia or because of extended exposure to ultraviolet irradiation need to be educated in the use of ultraviolet-blocking glasses and other means of reducing ocular exposure to ultraviolet light.

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Saw SM, Tan D. Pterygium: prevalence, demography and risk factors. Ophthalmic Epidemiol. 1999 Sep. 6(3):219-28. [Medline].

Threlfall TJ, English DR. Sun exposure and pterygium of the eye: a dose-response curve. Am J Ophthalmol. 1999 Sep. 128(3):280-7. [Medline].

Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, et al. Outcome of pterygium surgery: analysis over 14 years. Eye. 2005 Nov. 19(11):1182-90. [Medline].

Starck T, Kenyon KR, Serrano F. Conjunctival autograft for primary and recurrent pterygia: surgical technique and problem management. Cornea. 1991 May. 10(3):196-202. [Medline].

Blum HF. Carcinogenesis by Ultraviolet Light. Princeton University Press; 1959.

Srinivasan S, Slomovic AR. Eye rubbing causing conjunctival graft dehiscence following pterygium surgery with fibrin glue. Eye. 2007 Jun. 21(6):865-7. [Medline].

Anduze AL. Pterygium surgery with mitomycin-C: ten-year results. Ophthalmic Surg Lasers. 2001 Jul-Aug. 32(4):341-5. [Medline].

Raiskup F, Solomon A, Landau D, Ilsar M, Frucht-Pery J. Mitomycin C for pterygium: long term evaluation. Br J Ophthalmol. 2004 Nov. 88(11):1425-8. [Medline].

Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S, et al. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology. 1992 Nov. 99(11):1647-54. [Medline].

Oguz H. Amniotic membrane grafting versus conjunctival autografting in pterygium surgery. Clin Experiment Ophthalmol. 2005 Aug. 33(4):447-8. [Medline].

Miyai T, Hara R, Nejima R, Miyata K, Yonemura T, Amano S. Limbal allograft, amniotic membrane transplantation, and intraoperative mitomycin C for recurrent pterygium. Ophthalmology. 2005 Jul. 112(7):1263-7. [Medline].

Ti SE, Chee SP, Dear KB, Tan DT. Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol. 2000 Apr. 84(4):385-9. [Medline].

Yao YF, Qiu WY, Zhang YM, Tseng SC. Mitomycin C, amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with symblepharon and motility restriction. Graefes Arch Clin Exp Ophthalmol. 2006 Feb. 244(2):232-6. [Medline].

Cogan DG, Kuwabara T, Howard J. The nonelastic nature of pingueculas. Arch Ophthalmol. 1959. 61:388.

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Bahar I, Weinberger D, Gaton DD, Avisar R. Fibrin glue versus vicryl sutures for primary conjunctival closure in pterygium surgery: long-term results. Curr Eye Res. 2007 May. 32(5):399-405. [Medline].

Cohen RA, McDonald MB. Fixation of conjunctival autografts with an organic tissue adhesive. Arch Ophthalmol. 1993 Sep. 111(9):1167-8. [Medline].

Jain AK, Bansal R, Sukhija J. Human amniotic membrane transplantation with fibrin glue in management of primary pterygia: a new tuck-in technique. Cornea. 2008 Jan. 27(1):94-9. [Medline].

Kheirkhah A, Casas V, Sheha H, Raju VK, Tseng SC. Role of conjunctival inflammation in surgical outcome after amniotic membrane transplantation with or without fibrin glue for pterygium. Cornea. 2008 Jan. 27(1):56-63. [Medline].

Uy HS, Reyes JM, Flores JD, Lim-Bon-Siong R. Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmology. 2005 Apr. 112(4):667-71. [Medline].

Kheirkhah A, Nazari R, Nikdel M, et al. Postoperative conjunctival inflammation after pterygium surgery with amniotic membrane transplantation versus conjunctival autograft. Am J Ophthalmol. 2011 Nov. 152(5):733-8. [Medline].

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Kheirkhah A, Izadi A, Kiarudi MY, Nazari R, Hashemian H, Behrouz MJ. Effects of mitomycin C on corneal endothelial cell counts in pterygium surgery: role of application location. Am J Ophthalmol. 2011 Mar. 151(3):488-93. [Medline].

Bahar I, Kaiserman I, Lange AP, Slomovic A, Levinger E, Sansanayudh W, et al. The effect of mitomycin C on corneal endothelium in pterygium surgery. Am J Ophthalmol. 2009 Mar. 147(3):447-452.e1. [Medline].

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Hirst LW. Recurrence and complications after 1,000 surgeries using pterygium extended removal followed by extended conjunctival transplant. Ophthalmology. 2012 Nov. 119(11):2205-10. [Medline].

Singh G, Wilson MR, Foster CS. Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea. 1990 Oct. 9(4):331-4. [Medline].

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Jerome P Fisher, MD, FACS Volunteer Associate Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Leonard M Miller School of Medicine

Jerome P Fisher, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

William B Trattler, MD Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute

William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Received consulting fee from Allergan for consulting; Received consulting fee from Alcon for consulting; Received consulting fee from Bausch & Lomb for consulting; Received consulting fee from Abbott Medical Optics for consulting; Received consulting fee from CXLUSA for none; Received consulting fee from LensAR for none.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, AAO, OMIC, Allergan; Avedro; Bio-Tissue; GSK, Novartis; Shire; Sun Ophthalmics; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Avedro; Bio-Tissue; Shire.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Pterygium

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