Pterygium
Pterygium is a fleshy, triangular growth on the eye that develops mainly from prolonged sun exposure. While usually harmless, it can cause irritation and affect vision if left to grow across the cornea.
Table of contents
- What is pterygium?
- Causes and risk factors
- Symptoms
- How pterygium is diagnosed
- Treatment options
- Prevention
- Outlook
surfer’s eye
- Eye
- Conjunctiva
- Cornea
What is pterygium?
A pterygium is a raised, fleshy growth that develops on the surface of the eye. It grows on the conjunctiva (the clear membrane covering the white part of the eye) and can extend onto the cornea (the clear front window of the eye that covers the colored part)[1][2]. The growth typically appears as a triangular or wing-shaped patch of tissue. In fact, the word “pterygium” comes from Greek words meaning “wing” or “fin”[1][4].
The growth is usually whiteish or pinkish in color and may have visible blood vessels running through it[1][7]. Most commonly, pterygium starts in the inner corner of the eye (closest to the nose) and grows toward the center of the eye. Less frequently, it can develop from the outer corner or affect both sides of the eye at the same time[3][14]. One or both eyes may be affected[3].
This condition is commonly known as “surfer’s eye” because surfers frequently develop it due to their prolonged exposure to sun, wind, sand, and salt water[1][7]. However, anyone who spends significant time outdoors can develop a pterygium.
It’s important to know that pterygium is not cancerous. It does not invade the inside of the eye or spread to other parts of the face or body[3][14]. About one in every 100 people in some countries develops this condition[3].
Causes and risk factors
The exact cause of pterygium is not completely understood, but researchers have identified several important risk factors. The main cause is long-term exposure to ultraviolet (UV) light from the sun[1][2]. The condition is much more common in tropical regions within about 40 degrees latitude of the equator, where sunlight is more intense[4][19].
Besides UV exposure, other environmental factors contribute to pterygium development. These include chronic irritation from hot and dry weather, wind, dust, and sandy conditions[1][2]. People who work outdoors face particularly high risk, including farmers, fishermen, sailors, and gardeners[19].
Certain groups of people are more likely to develop pterygium. It is more common in older adults, especially those over 60, who have had more years of sun exposure[1][3]. Men are affected about twice as often as women[11]. The condition typically appears in people between 20 and 40 years of age[7].
Other possible risk factors include genetics, vitamin A deficiency, and possibly human papilloma virus (HPV)[1]. Some research suggests that dry eye conditions may also increase risk[8][23].
Symptoms
Many people with pterygium may not notice any symptoms at first. The only sign might be the visible growth itself – a raised, fleshy, wedge-shaped area at the corner of the eye[1][7].
When symptoms do develop, they can range from mild to severe. Common symptoms include redness of the eye or bloodshot appearance, a feeling like something is stuck in your eye (called foreign body sensation), eye itching, burning sensation, eye pain, and excessive tearing or watery eyes[1][3][14].
The growth may also cause inflammation and swelling, a condition called conjunctivitis[1]. Some people experience dry eye symptoms alongside their pterygium[1].
If the pterygium continues to grow, it can lead to more serious problems. As it extends across the cornea, it may cause blurred or distorted vision, or even double vision in rare cases[1][8]. The growth can create irregular astigmatism (abnormal curvature of the eye’s surface), which affects how clearly you see[6][19].
Some people also experience difficulties or discomfort when wearing contact lenses[1][8]. Not everyone develops all these symptoms, and some pterygia grow more than others[1].
How pterygium is diagnosed
Diagnosing pterygium is usually straightforward. An eye care provider can recognize a pterygium simply by looking at it during an eye examination[3][6].
Your eye doctor will typically use a slit lamp exam to examine your eye more closely. A slit lamp is a special type of microscope that focuses a narrow line of bright light on your eye, allowing the doctor to see the front and inside of your eye in detail[1][3]. This is part of a standard comprehensive eye examination.
During the examination, your doctor will measure how far the pterygium extends from the edge of the cornea (called the limbus) to its highest point on the cornea. This measurement is recorded so that at future visits, the doctor can tell if the pterygium has grown[8].
Your eye care provider will also check your visual acuity (how well you see) and perform a complete eye examination to look for other possible causes of discomfort or vision problems[24]. They may use a technique called retinoscopy to check for astigmatism caused by the pterygium[24].
In some cases, specialized tests like corneal topography may be used to measure the shape of the cornea and detect any distortion caused by the pterygium[6][24]. Generally, no other special tests are needed[3][14].
Treatment options
Not all pterygia require treatment. If your pterygium is small and not causing symptoms, your doctor may simply recommend monitoring it over time[2][3].
Non-surgical treatments
For mild symptoms, several non-surgical approaches can help. Artificial tears (lubricating eye drops) are commonly recommended to keep the eyes moist and reduce irritation[2][3][8]. These over-the-counter drops can help prevent the pterygium from becoming inflamed and potentially slow its growth.
If the pterygium becomes inflamed, your doctor may prescribe mild steroid eye drops or ointments to reduce redness, pain, itching, and swelling[1][2][8]. Anti-inflammatory drops may also be used[8].
Surgery
Surgery to remove a pterygium is usually considered only when necessary. Your doctor might recommend surgery if the pterygium is blocking or threatening your central vision, causing significant vision loss from astigmatism, restricting eye movement, continuing to grow despite other treatments, or if it has an unusual appearance that raises concerns[24].
Some people also choose surgery for cosmetic reasons if they are self-conscious about how the pterygium looks[8][11].
Pterygium surgery is typically performed as an outpatient procedure under local anesthesia with sedation if needed[10][11]. The procedure usually takes 30 minutes to an hour[11][18].
Simply cutting out the pterygium is not enough, as this approach is associated with a high recurrence rate (the pterygium growing back) of about 80 percent. In fact, 97 percent of regrowth occurs in the first year after simple removal[8].
To reduce the risk of recurrence, surgeons often use a technique called conjunctival autograft. This involves removing some healthy conjunctiva tissue from another part of the same eye and using it to cover the area where the pterygium was removed[8][13]. This method significantly reduces recurrence rates, though the pterygium can still return in some cases[8].
Recovery from pterygium surgery typically takes about six weeks[18]. Some discomfort and redness after surgery is normal[18]. The highest risk of the pterygium returning is during the first 12 months after surgery[18].
Prevention
Because ultraviolet light is the main cause of pterygium, protecting your eyes from the sun is the most important preventive measure. This is especially crucial for people who spend a lot of time outdoors[3][19].
The best way to protect your eyes is to wear sunglasses that block 100 percent of UV rays (both UVA and UVB). Look for labels that say “100% UV protection,” “UV 400,” or have an EPF rating of 9 or 10[19][23]. Wrap-around and close-fitting sunglasses offer better protection than smaller frames because they block UV light coming from the sides[19].
Wearing a wide-brimmed hat along with UV-blocking sunglasses provides additional protection[2][3][19]. It’s important to wear this protection all the time when outdoors, even during winter or on cloudy days, because UV light can reflect off various surfaces including windows, water, sand, and snow[19].
Protection should start at a young age. Children should be kept away from intense sun, especially in mid-afternoon. If they must be outdoors, make sure they wear wide-brimmed hats and UV-blocking sunglasses[19]. Using strollers with awnings or hoods can help protect young children from excessive sunlight[19].
Besides sun protection, try to avoid exposure to harsh environmental conditions when possible. If you already have an early pterygium, further irritation by wind, sand, and dust can inflame it and encourage more growth[19]. If you must be in very windy, dusty, or sandy conditions, wear protective eyewear[19].
After pterygium surgery, continuing these preventive measures is crucial to reduce the risk of the pterygium coming back[18].
Outlook
The outlook for people with pterygium is generally good. Most pterygia cause no problems and do not need surgical treatment[2]. The condition is not serious in most cases and does not lead to permanent vision loss[1].
A pterygium is not an invasive growth. It is not cancerous and will not spread to other nearby tissues or other parts of the body[1][3]. However, it can continue to grow slowly across the surface of the eye over months to years[4][7].
If a pterygium reaches the cornea and begins to cover the pupil, it can interfere with vision. In this case, surgery to remove it can have good results[2]. Most symptoms improve after successful removal.
The main challenge with pterygium is that it can return even after successful surgery[3][14][18]. Modern surgical techniques using conjunctival grafts have significantly reduced recurrence rates, but regrowth remains possible.
People who have had a pterygium should see an eye care professional regularly for monitoring[2]. If you have had a pterygium removed and symptoms return, contact your eye doctor[2].
