This patient-education article is written by the cornea service at Suraj Eye Institute, Nagpur.

Why Surgery is Offered

Pterygium is a slowly growing wing of fibrovascular tissue that creeps onto the cornea from the conjunctiva. Surgery is offered when the pterygium causes significant cosmetic concern, persistent irritation despite lubricants, induced astigmatism that reduces vision, or when the head approaches the visual axis. Earlier surgery on a smaller, quieter pterygium gives a better outcome than delayed surgery on a large, vascular one.

The Modern Operation

The standard procedure is pterygium excision with conjunctival autograft. It has three steps. A small slip of healthy conjunctiva is harvested from elsewhere on the same eye (usually under the upper eyelid) and transplanted to the bare sclera that remains after the pterygium has been removed. This autograft prevents the abnormal scar tissue and blood vessels of the pterygium from growing back — the main risk of pterygium surgery is recurrence.

Pterygium Excision with Conjunctival Autograft

Pterygium Excision with Conjunctival Autograft — Three Steps

1. Pterygium

2. Excision & bare sclera

3. Autograft + glue

Pterygium head on cornea, body and vessels on conjunctiva

Pterygium dissected off cornea and conjunctiva; bare sclera

Healthy conjunctiva from upper bulbar surface placed and glued

The autograft covers the bare sclera and prevents recurrence of the abnormal tissue.

Figure 1. The three steps of modern pterygium surgery. (1) The pterygium head is dissected off the cornea and the body is excised from the underlying conjunctiva. (2) The exposed sclera is left bare. (3) A slip of healthy conjunctiva harvested from under the upper eyelid of the same eye is placed onto the bare sclera and secured with fibrin tissue glue (or fine sutures). The autograft acts as a biological barrier and substantially reduces the chance that the abnormal pterygium tissue grows back.

What to Expect on the Day

The operation is usually performed under topical anaesthesia with peribulbar anaesthesia in selected cases, takes 30–45 minutes per eye, and is a day procedure. The eye is patched for several hours after surgery and reviewed the next day. A typical post-operative regime is:

  • Topical antibiotic drops for the first week
  • Topical steroid drops tapered over 4–6 weeks
  • Preservative-free lubricants for 8–12 weeks
  • Sunglasses outdoors

The eye is red and a little sore for the first one to two weeks. Most patients return to normal work and driving within a week.

Recurrence and Mitomycin C

The single most important advance in pterygium surgery is the move away from the “bare sclera” technique, in which the pterygium was excised and the sclera left to re-epithelialise unaided. Bare-sclera recurrence rates were unacceptably high. Conjunctival autograft dramatically reduces recurrence. Mitomycin C, a single intra-operative anti-fibrotic application, is used as an adjunct in recurrent or particularly large, vascular primary pterygia.

Earlier surgery is easier and recurs less. A small, quiet pterygium has a lower recurrence rate after surgery than a large, vascular one. Patients with progressing or symptomatic pterygium are best operated on while the lesion is still moderate.
✔ Pterygium Surgery at Suraj Eye Institute

We perform pterygium excision with conjunctival autograft and fibrin glue as the standard technique — substantially lower recurrence than the older bare-sclera operation. The autograft is harvested from the upper bulbar conjunctiva of the same eye. Adjunctive mitomycin C is used selectively in recurrent or high-risk pterygia.

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Frequently Asked Questions

Will my eye look normal after surgery?
Yes. The conjunctival autograft is taken from a hidden area under the upper eyelid and the cosmetic result is excellent once the redness settles over 4–6 weeks. The eye looks essentially normal at that point.

How likely is the pterygium to come back?
With modern excision plus conjunctival autograft, recurrence is substantially lower than with the older bare-sclera technique. Younger age at first surgery, large pre-operative lesions and very vascular pterygia carry the highest recurrence risk.

Is mitomycin C safe?
Used intra-operatively in low dose and for a short application time, mitomycin C is safe and is a valuable adjunct in recurrent pterygia and in very vascular primary disease. Long contact or higher concentrations have been associated with scleral thinning, which is why we restrict its use to specific indications.

Can both eyes be operated on at the same time?
We usually operate on one eye at a time so that the other eye is fully functional during the recovery period. The second eye is typically scheduled 4–8 weeks later if both are affected.

How can I prevent recurrence?
Consistent sunglasses (with side protection) outdoors, avoidance of dust and wind exposure where possible, lubrication and ocular surface care all reduce recurrence risk in the months after surgery — the period when the conjunctiva is most active.

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