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

What is a Pterygium?

A pterygium is a triangular, wing-shaped growth of fibrovascular tissue that starts on the bulbar conjunctiva and slowly extends onto the cornea, usually on the nasal side of the eye. A pinguecula is a related but smaller, yellow-white nodule on the conjunctiva that does not cross the limbus onto the cornea. Pinguecula is harmless; pterygium can affect vision if it advances far enough to cover the pupil or distort the corneal shape.

Both conditions are strongly linked to lifetime ultraviolet light exposure, wind and dust. They are particularly common in agricultural, outdoor and industrial workers in central India.

Pterygium — External View

Pterygium — External Appearance and Anatomy

Head (apex on cornea)

Neck (at limbus)

Body (on conjunctiva)

Slow growth toward the centre of the cornea

NASAL TEMPORAL

Figure 1. Pterygium is a triangular fibrovascular growth, usually nasal. The body sits on the bulbar conjunctiva, the neck straddles the limbus, and the head is the apex that has invaded the cornea. Growth is slow, over years. When the head encroaches towards the visual axis or induces astigmatism, surgery is offered.

Symptoms

Many pterygia are asymptomatic and discovered on routine examination. As they grow, patients describe a visible patch of redness, intermittent irritation, foreign-body sensation and watering, especially in dusty or windy conditions. Vision is affected only when:

  • The pterygium head approaches the pupil and physically obscures it, or
  • The pterygium induces significant astigmatism by flattening the cornea on its leading edge

How Pterygium is Diagnosed

Diagnosis is clinical. We measure how far the head has advanced (a horizontal distance from the limbus to the apex), assess vascularity and inflammation, and perform corneal topography to detect induced astigmatism. Anterior-segment OCT is used in atypical or recurrent cases to assess depth.

Treatment

Small, quiet pterygia need no surgery. Treatment options are:

  • Conservative — lubricants, short courses of mild topical anti-inflammatory drops, sunglasses with side protection, avoidance of dust
  • Surgery — pterygium excision with a conjunctival autograft, secured with fibrin glue, is the modern technique. The autograft (a thin slip of healthy conjunctiva taken from the upper bulbar surface of the same eye) covers the excision site and substantially reduces the chance of recurrence
Recurrence is the main complication of pterygium surgery. The old “bare sclera” technique had a high recurrence rate. With modern excision plus conjunctival autograft and glue, recurrence is substantially lower.

When Should I Have Surgery?

Surgery is offered when the pterygium causes significant cosmetic concern, persistent irritation despite lubricants, induced astigmatism that affects vision, or when the head is encroaching towards the visual axis. Earlier surgery, while the pterygium is small and not very vascular, gives a better visual and cosmetic outcome.

✔ Pterygium Care at Suraj Eye Institute

We offer pre-operative corneal topography and anterior-segment OCT to plan surgery, and routinely perform modern pterygium excision with conjunctival autograft using fibrin glue, which has substantially lower recurrence rates than the older bare-sclera technique.

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Frequently Asked Questions

Is a pterygium cancer?
No. Pterygium is a benign growth, not a tumour. However, suspicious or rapidly growing lesions on the conjunctiva — especially those that look different in colour, are very vascular or are unilateral and unusual — are sometimes biopsied to exclude rarer conditions such as ocular surface squamous neoplasia.

Will my pterygium definitely grow?
Not always. Many pterygia remain stable for years. Continued UV exposure, dust and dryness accelerate growth, so sun protection and lubrication can slow the process. Regular follow-up tells us whether the pterygium is changing.

Can I just have the redness treated without surgery?
Anti-inflammatory drops settle inflammation in the short term, but do not reverse the growth on the cornea. Once vision is affected or symptoms are persistent, surgery is the only definitive treatment.

Will the pterygium come back after surgery?
Modern surgery with conjunctival autograft and fibrin glue has substantially reduced recurrence compared with the older bare-sclera technique. Younger age, large pre-operative lesions and very vascular pterygia carry the highest recurrence risk.

Can I prevent pterygium from forming?
Reducing lifetime ultraviolet exposure (a hat with a brim, wraparound sunglasses with UV filtration), avoiding chronic dust and wind exposure where possible, and lubricating the eyes when working outdoors all help, particularly in agricultural and outdoor occupations.

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