Pterygium: Causes, Symptoms, Surgery and Prevention of Recurrence

Author: Dr Val Phua
Estimated reading time: 11–13 minutes

What Is the Fleshy Growth on the Surface of My Eye?

A pterygium is a triangular or wing-shaped growth of conjunctival tissue that extends from the white part of the eye onto the cornea.

The conjunctiva is the thin transparent membrane covering the white of the eye. The cornea is the clear front window through which light enters.

A pterygium most commonly develops on the side of the eye nearest the nose, although it may occur on the outer side, affect both sides of one eye or develop in both eyes.

It may cause:

• Redness
• Irritation
• Dryness or grittiness
• A visible fleshy growth
• Increasing astigmatism
• Blurred or distorted vision
• Difficulty wearing contact lenses

Pterygia are usually benign. Small stable growths may require only observation, lubrication and ultraviolet protection. Surgery may be recommended when the pterygium progresses, affects vision, repeatedly becomes inflamed or causes significant cosmetic concern.

What Does a Pterygium Look Like?

A pterygium usually appears as a raised, pink or reddish triangular growth.

It has three general parts:

• The body, located over the white conjunctiva
• The neck, where the tissue crosses the edge of the cornea
• The head, which advances onto the cornea

Some pterygia are thin and relatively transparent. Others are thick, fleshy and contain prominent blood vessels.

The appearance may change temporarily when the eye becomes:

• Dry
• Exposed to wind
• Irritated by dust
• Inflamed
• Exposed to prolonged sunlight
• Affected by allergy

A red pterygium is not necessarily growing rapidly. However, increasing corneal extension or a change documented on photographs or examination may indicate true progression.

Why Does It Usually Grow from the Nasal Side?

Most pterygia begin on the nasal side of the eye.

One explanation is that light entering from the side may be refracted across the cornea and concentrated near the nasal limbus—the border between the cornea and conjunctiva. This may increase ultraviolet exposure at that location.

The precise biological process is complex, involving ultraviolet-related cellular injury, inflammation, abnormal wound healing, blood-vessel growth and fibrovascular tissue proliferation.

Is a Pterygium a Tumour or Cancer?

A typical pterygium is benign and is not a cancer.

However, not every growth near the edge of the cornea is necessarily a pterygium. Ocular-surface squamous neoplasia and other conjunctival lesions can occasionally have a similar appearance.

Features that may require closer assessment include:

• An unusually elevated or nodular lesion
• An irregular or gelatinous surface
• Prominent abnormal feeder vessels
• Unusual pigmentation
• Rapid growth
• A lesion in an atypical location
• Significant loss of normal limbal architecture
• Recurrence with an unusual appearance
• Failure to resemble an ordinary pterygium clinically

Suspicious or atypical tissue may be sent for histopathological examination after removal. Ocular-surface neoplasia can present in variable ways, so atypical lesions should not automatically be treated as harmless pterygia.

What Causes Pterygium?

The strongest established environmental association is cumulative ultraviolet exposure.

Other contributing factors may include:

• Outdoor work or recreation
• Wind
• Dust
• Dry environments
• Chronic ocular-surface irritation
• Genetic susceptibility
• Increasing age
• Living in sunny climates

Studies have consistently found an association between pterygium, cumulative ocular sunlight exposure and outdoor activity.

Why Is Ultraviolet Light Important?

Repeated ultraviolet exposure may damage cells and supporting tissue around the limbus.

This may promote:

• Oxidative stress
• Chronic inflammation
• Abnormal blood-vessel formation
• Breakdown and remodelling of collagen
• Migration of conjunctival tissue onto the cornea
• Altered limbal stem-cell function

Pterygium is therefore sometimes called surfer’s eye, but it is not limited to surfers. Farmers, construction workers, sailors, runners, golfers, outdoor coaches and anyone with substantial cumulative outdoor exposure may be affected.

Can Pterygium Be Prevented?

No preventive measure can guarantee that a pterygium will never develop, particularly when genetic and occupational factors are present.

Risk may be reduced by:

• Wearing sunglasses that provide appropriate ultraviolet protection
• Choosing wraparound or close-fitting frames that reduce light entering from the side
• Wearing a wide-brimmed hat
• Seeking shade during intense sunlight
• Using protective eyewear in dusty or windy environments
• Treating dry eye and allergy
• Avoiding unnecessary eye rubbing

UV protection remains important after surgery because the biological tendency associated with sunlight exposure does not disappear when the visible pterygium is removed.

What Symptoms Can a Pterygium Cause?

Redness

A pterygium contains blood vessels and may become more visibly red when inflamed.

Redness may fluctuate with:

• Dry weather
• Air conditioning
• Wind
• Dust
• Smoke
• Allergy
• Prolonged outdoor activity
• Inadequate lubrication

Persistent redness may also come from dry eye, blepharitis, allergy or another ocular-surface condition rather than from the pterygium alone.

Grittiness or Foreign-Body Sensation

The raised tissue may disturb the smooth ocular surface and tear film.

Patients may describe:

• Sand in the eye
• Scratching
• Burning
• Intermittent discomfort
• Awareness of something near the inner corner

Lubricating drops may improve symptoms but do not remove or shrink the growth.

Dry or Watery Eyes

A pterygium can disrupt the normal spreading of tears across the cornea.

This may cause dryness, but irritation can also trigger reflex tearing. Watery eyes therefore do not exclude ocular-surface dryness.

Contact-Lens Discomfort

A raised pterygium may interfere with:

• Lens centration
• Lens movement
• Tear circulation beneath the lens
• Comfortable lens wear

Contact lenses may also irritate an already inflamed ocular surface.

Cosmetic Concern

Some patients are concerned about:

• The visible red or fleshy appearance
• Persistent asymmetry between the eyes
• How the eye appears in photographs
• Questions from others about eye redness
• The impression that the eye is constantly irritated

Cosmetic concern can be a legitimate reason to discuss surgery, but the expected appearance, recovery and recurrence risk should be explained carefully.

Blurred or Distorted Vision

A pterygium can affect vision before it reaches the pupil.

As it pulls on and flattens the adjacent cornea, it may cause:

• Increasing astigmatism
• Irregular astigmatism
• Higher-order optical aberrations
• Ghost images
• Glare
• Reduced contrast
• Fluctuating spectacle power

The larger the corneal extension and surface area, the greater the potential effect on corneal shape and optical quality.

Does It Have to Cover the Pupil Before Vision Is Affected?

No.

A pterygium does not need to reach the centre of the cornea before affecting vision.

It may reduce visual quality by:

• Flattening one part of the cornea
• Inducing regular or irregular astigmatism
• Distorting corneal topography
• Disrupting the tear film
• Increasing glare and optical aberrations

A growth approaching the visual axis may eventually cause direct obstruction and scarring, but optical distortion often develops earlier.

What Is the Difference Between a Pterygium and a Pinguecula?

Both are associated with chronic environmental exposure and degeneration of conjunctival tissue, but they are not identical.

Pinguecula

A pinguecula is:

• A yellowish or slightly raised area on the conjunctiva
• Usually located near the cornea
• Confined to the white part of the eye
• Unable to grow directly across the cornea in its existing form

It may become inflamed, causing pingueculitis.

Pterygium

A pterygium:

• Is fibrovascular and often triangular
• Crosses the limbus
• Extends onto the cornea
• May alter corneal shape and vision

A pinguecula does not require surgery simply because it is visible. Treatment is usually directed at irritation unless the lesion is atypical or significantly symptomatic.

What Is a Pseudopterygium?

A pseudopterygium is an adhesion between conjunctiva and cornea caused by previous injury or inflammation rather than the typical degenerative pterygium process.

Possible causes include:

• Chemical injury
• Thermal injury
• Corneal ulceration
• Severe inflammation
• Trauma
• Previous surgery

Unlike an ordinary pterygium, a pseudopterygium may occur at almost any location around the cornea.

Distinguishing between the two matters because the underlying ocular-surface condition and surgical approach may differ.

How Is Pterygium Diagnosed?

Diagnosis is usually made through clinical examination.

Medical and Exposure History

Your ophthalmologist may ask about:

• Outdoor occupation or sport
• Ultraviolet exposure
• Eye rubbing
• Allergy
• Dry-eye symptoms
• Previous eye injury
• Previous pterygium surgery
• Contact-lens wear
• Change in appearance
• Visual symptoms

Visual Acuity and Refraction

Vision and spectacle power are measured.

The examination may identify:

• Increasing astigmatism
• Irregular refraction
• Reduced best-corrected vision
• A difference between the eyes

Slit-Lamp Examination

A slit lamp allows detailed examination of:

• Pterygium size
• Corneal extension
• Thickness and vascularity
• Inflammation
• Corneal scarring
• Tear-film disturbance
• Features that might suggest another diagnosis

Photography

Anterior-segment photography can document the pterygium’s:

• Length
• Width
• Vascularity
• Appearance
• Relationship to the visual axis

Comparing photographs over time can help distinguish true progression from temporary inflammation.

Corneal Topography or Tomography

Corneal imaging may be useful when:

• Vision is affected
• Astigmatism is changing
• Cataract surgery is being planned
• Refractive surgery is being considered
• The pterygium is moderately large
• The degree of optical distortion is uncertain

The scan can demonstrate corneal flattening, asymmetry and irregular astigmatism caused by the growth.

Does Every Pterygium Need Surgery?

No.

Most small, stable and minimally symptomatic pterygia can be monitored.

Observation may be appropriate when:

• Vision remains good
• The growth is stable
• Astigmatism is not significantly affected
• Irritation is mild and manageable
• The appearance is acceptable to the patient
• There are no suspicious clinical features

Surgery is the only way to remove the tissue, but surgery is not automatically better than observation because recurrence and postoperative complications are possible.

Can Eye Drops Make a Pterygium Disappear?

No eye drop has been proven to dissolve or permanently shrink an established pterygium.

Drops may improve associated symptoms.

Possible treatments include:

• Preservative-free artificial tears
• Lubricating gels
• Anti-allergy medication
• A short supervised course of anti-inflammatory drops
• Treatment of blepharitis or dry eye

Steroid drops should not be self-started or used continuously without supervision because they can raise eye pressure, promote infection and contribute to cataract formation.

When Should Surgery Be Considered?

Surgery may be recommended for one or more of the following reasons.

Progressive Growth

Increasing extension towards the central cornea raises the risk of:

• Greater astigmatism
• Irregular corneal shape
• Visual-axis involvement
• Corneal scarring
• More complex future surgery

Growth is best assessed using serial measurements or photographs rather than memory alone.

Visual Disturbance

Surgery may be appropriate when the pterygium causes:

• Reduced visual acuity
• Increasing astigmatism
• Irregular astigmatism
• Ghosting or distortion
• Glare
• Difficulty obtaining a stable spectacle prescription

Pterygium excision can reduce induced astigmatism and improve corneal regularity, although the final result depends on size, pre-existing scarring and the health of the rest of the eye.

Persistent Irritation

Surgery may be considered when recurrent redness, grittiness or inflammation remains troublesome despite:

• Lubrication
• Allergy control
• Environmental protection
• Treatment of associated ocular-surface disease

Removing a pterygium may not eliminate all irritation if dry eye, allergy or blepharitis is also present.

Contact-Lens Intolerance

A pterygium that repeatedly interferes with lens fit or comfort may justify removal after other causes of contact-lens discomfort have been addressed.

Restricted Eye Movement

Large or recurrent pterygia can cause conjunctival scarring and restrict eye movement.

This may produce:

• Pulling discomfort
• Double vision
• Limited outward eye movement
• Significant ocular-surface distortion

These complex cases may require more extensive reconstruction.

Cosmetic Concern

Surgery may be considered when the appearance causes substantial concern.

Patients should understand that:

• The eye is usually red during early recovery.
• A small scar or blood vessel may remain.
• The appearance may continue improving for months.
• Perfectly white, symmetrical eyes cannot be guaranteed.
• Recurrence may be redder and more aggressive than the original growth.

Before Cataract or Refractive Surgery

A moderate or large pterygium may distort:

• Keratometry
• Corneal topography
• Astigmatism measurements
• Intraocular-lens calculations
• Toric lens planning

Removing the pterygium before cataract or refractive surgery may improve measurement accuracy.

The cornea needs time to stabilise after removal. A 2026 study found that stabilisation depended partly on how far the pterygium had invaded the cornea, recommending at least 16 weeks before cataract planning and approximately 20 weeks for larger lesions in that study population.

Smaller studies have reported earlier stabilisation, so timing should be individualised using repeat keratometry rather than a fixed universal interval.

Should Pterygium and Cataract Surgery Be Performed Together?

Combined surgery is possible in selected patients.

Potential Advantages

• One operating session
• One period of leave
• Faster overall rehabilitation

Potential Disadvantages

• Less predictable intraocular-lens calculations
• Corneal-shape change after pterygium removal
• More postoperative inflammation
• Difficulty determining the cause of residual blur
• Potentially less predictable toric-lens outcomes

Staged surgery is often preferable when the pterygium significantly alters corneal measurements or when a highly accurate refractive outcome is important.

What Happens During Pterygium Surgery?

The operation is usually performed as day surgery under local anaesthesia.

A typical procedure involves:

1. Anaesthetising the eye
2. Removing the pterygium from the cornea
3. Excising abnormal fibrovascular tissue from the scleral surface
4. Smoothing the corneal area
5. Covering the exposed area with a graft
6. Securing the graft with glue, sutures or another fixation method
7. Applying postoperative antibiotic and anti-inflammatory medication

The exact technique varies according to:

• Primary versus recurrent disease
• Pterygium size
• Amount of conjunctival scarring
• Glaucoma-surgery requirements
• Surgeon preference
• Available graft tissue

Why Is the Bare-Sclera Technique Generally Avoided?

In a bare-sclera excision, the pterygium is removed and the underlying white sclera is left uncovered.

This method is quick but has historically been associated with high recurrence rates. Recurrent tissue may be thicker, more inflamed and more difficult to treat than the original pterygium.

Modern surgery usually covers the exposed area with healthy conjunctiva or another graft material.

What Is a Conjunctival Autograft?

A conjunctival autograft uses a thin piece of the patient’s own healthy conjunctiva, usually taken from beneath the upper eyelid.

The graft is placed over the area where the pterygium was removed.

Benefits include:

• Covering the exposed sclera
• Reconstructing the ocular surface
• Reducing fibrovascular regrowth
• Providing good cosmetic integration
• Lowering recurrence compared with simple excision

Systematic reviews and more recent surgical series support conjunctival autografting as a preferred technique for many primary pterygia because of its relatively low recurrence rate.

What Is a Limbal-Conjunctival Autograft?

A limbal-conjunctival autograft includes a thin strip of tissue from near the limbus.

The intention is to restore a barrier between conjunctiva and cornea and reduce recurrence.

This may be particularly useful in selected:

• Young patients
• Fleshy pterygia
• Recurrent pterygia
• High-risk cases

The graft must be harvested carefully to avoid unnecessary damage to the donor-site limbal tissue.

What Is an Amniotic-Membrane Graft?

Amniotic membrane is processed donor tissue derived from the innermost layer of the placenta.

It may be used when:

• The pterygium is extensive
• Conjunctival tissue must be preserved
• Significant surface reconstruction is required
• Both nasal and temporal lesions are present
• Previous surgery has reduced available conjunctiva
• Future glaucoma surgery may require superior conjunctiva

Amniotic membrane has useful anti-inflammatory and healing properties. However, when used alone for ordinary primary pterygium surgery, it has generally been associated with higher recurrence than conjunctival autografting.

How Is the Graft Attached?

Fibrin Glue

Fibrin tissue adhesive can reduce:

• Operating time
• Suture-related irritation
• Early postoperative discomfort

Recent pooled evidence suggests fibrin glue may also be associated with lower recurrence than sutures in primary conjunctival-autograft surgery, although cost, availability and rare biological-product risks must be considered.

Sutures

Sutures provide secure graft fixation and may be preferred when:

• The graft is under tension
• The ocular surface is complex
• Glue is unavailable
• The surgeon wants precise edge control

Sutures may cause more early irritation and sometimes require later removal.

Autologous Blood or Sutureless, Glue-Free Fixation

The patient’s own blood may be used to secure the graft in selected techniques.

Advantages include avoiding sutures and commercial glue. However, graft displacement, retraction or loss may occur more frequently if fixation is inadequate.

A 2026 network meta-analysis found that fibrin glue had the most favourable overall recurrence profile, while suture fixation provided strong graft stability and autologous blood required selective use.

What Is Mitomycin C?

Mitomycin C is an antimetabolite medication that reduces fibroblast proliferation.

It may be used during selected pterygium operations to reduce recurrence risk, particularly in:

• Recurrent pterygium
• Aggressive fleshy lesions
• Young high-risk patients
• Significant conjunctival scarring
• Complex ocular-surface reconstruction

The concentration and exposure time must be carefully controlled.

Potential complications include:

• Delayed healing
• Corneal or scleral thinning
• Scleral melt
• Infection
• Inflammation
• Glaucoma
• Corneal perforation
• Endothelial-cell damage

Mitomycin C should therefore be used as a targeted surgical adjunct rather than a harmless routine addition.

Is the Removed Tissue Sent to the Laboratory?

Practices vary.

Histopathology may be particularly appropriate when:

• The appearance is atypical
• Growth has been rapid
• The lesion is unusually thick, irregular or vascular
• Pigmentation is present
• The location is unusual
• The diagnosis is uncertain
• The pterygium is recurrent
• Ocular-surface neoplasia is a concern

Some surgeons routinely send excised tissue for analysis because unexpected atypia may occasionally be detected.

What Should I Expect Immediately After Surgery?

Common early symptoms include:

• Redness
• Watering
• Grittiness
• Mild to moderate pain
• Light sensitivity
• Blurred vision
• Eyelid swelling
• A blood-red patch around the graft

The eye may initially look more inflamed than it did before surgery. This usually improves gradually.

The graft may appear:

• Pink
• Slightly swollen
• Uneven
• Surrounded by small blood vessels

It generally becomes smoother and less noticeable during healing.

Is Pterygium Surgery Painful?

Local anaesthesia is used during surgery.

Patients may feel:

• Pressure
• Touch
• Movement
• Bright light

After surgery, discomfort may be caused by:

• The corneal epithelial defect
• Sutures
• Surface inflammation
• Eyelid movement over the healing area

Pain is usually most noticeable during the first few days.

Severe or worsening pain requires review because it may indicate infection, graft displacement, corneal epithelial problems or raised eye pressure.

What Is the Recovery Timeline?

First Few Days

You may experience:

• Grittiness
• Watering
• Light sensitivity
• Redness
• Blurred vision

Prescribed drops should be used exactly as instructed.

First One to Two Weeks

The corneal surface generally becomes more comfortable.

Redness remains visible, and vision may still fluctuate.

Patients with sutures may remain more aware of irritation.

First One to Three Months

The graft gradually becomes:

• Flatter
• Less red
• Better integrated
• More comfortable

Astigmatism and spectacle power may continue changing as the cornea stabilises.

Several Months

Final cosmetic appearance and corneal measurements may take several months to settle, particularly after removal of a large pterygium.

When Can I Return to Work?

Return to work depends on:

• Size of the operation
• Type of occupation
• Comfort
• Visual recovery
• Exposure to dust, sunlight or contaminated environments
• Whether one or both eyes were treated

Office workers may return earlier than patients working outdoors, in construction or in dusty industrial settings.

When Can I Drive?

Do not drive while:

• Vision remains blurred
• Light sensitivity is significant
• The eye is painful
• Depth perception is affected
• Dilating medication remains active
• You do not meet the legal visual requirement

Your surgeon should advise when driving is appropriate.

What Should I Avoid After Surgery?

Follow the surgeon’s specific instructions.

Temporary precautions commonly include:

• Do not rub the eye.
• Avoid swimming and hot tubs.
• Avoid eye makeup.
• Keep soap and shampoo out of the eye.
• Avoid dusty or smoky environments.
• Avoid strenuous exercise for the advised period.
• Wear an eye shield while sleeping if instructed.
• Use sunglasses outdoors.
• Avoid contact lenses until the surface has healed and the fit is reassessed.
• Attend every follow-up appointment.

What Drops Are Used After Surgery?

Medication may include:

• Antibiotic drops
• Steroid anti-inflammatory drops
• Preservative-free artificial tears
• Ointment or gel
• Other medication according to healing

Steroid drops are often reduced gradually over several weeks.

Do not stop them abruptly or continue them longer than advised. Eye pressure may need monitoring during treatment.

What Are the Possible Complications?

Potential complications include:

• Recurrence
• Graft displacement or loss
• Graft swelling
• Infection
• Persistent epithelial defect
• Corneal or scleral thinning
• Conjunctival granuloma
• Dellen formation
• Scarring
• Double vision
• Restricted eye movement
• Raised eye pressure
• Persistent redness
• Unsatisfactory cosmetic appearance
• Rare loss of vision

Recent large surgical series using modern graft techniques have reported low overall recurrence and complication rates, but results depend on lesion type, technique, surgeon experience and duration of follow-up.

What Does Recurrence Mean?

Recurrence means fibrovascular tissue begins growing back across the limbus towards the cornea.

Early postoperative redness alone is not necessarily recurrence.

Signs of recurrence may include:

• Increasing thick vascular tissue
• Progressive extension towards the cornea
• New traction or scarring
• Increasing redness after initial improvement
• A visible advancing edge

Most recurrences develop during the first several months, although later recurrence is possible.

Why Can a Recurrent Pterygium Be More Difficult?

Recurrent pterygia may be:

• Thicker
• More vascular
• More inflamed
• More adherent to the sclera and extraocular muscles
• Associated with greater conjunctival scarring
• More likely to restrict eye movement
• More difficult to reconstruct cosmetically

Preventing the first recurrence is therefore an important goal of primary surgery.

Who Has a Higher Risk of Recurrence?

Factors associated with recurrence may include:

• Younger age
• Fleshy or highly vascular morphology
• Large or recurrent disease
• Continued high ultraviolet exposure
• Significant postoperative inflammation
• Incomplete removal of abnormal fibrovascular tissue
• Graft displacement or inadequate coverage
• Certain surgical techniques

Younger age has repeatedly been identified as a recurrence risk factor, although the importance of individual features varies with the surgical method used.

How Can Recurrence Risk Be Reduced?

Measures include:

• Using an appropriate graft technique
• Ensuring good graft positioning
• Controlling postoperative inflammation
• Completing the prescribed drop course
• Avoiding eye rubbing
• Protecting the eyes from ultraviolet exposure
• Treating allergy and dry eye
• Attending postoperative reviews
• Using mitomycin C selectively in appropriate high-risk cases

Even technically successful surgery cannot reduce recurrence risk to zero.

Will Surgery Completely Remove the Redness?

The appearance usually improves, but a perfectly white eye cannot be guaranteed.

Residual redness may arise from:

• Normal postoperative healing
• Persistent blood vessels
• Dry eye
• Allergy
• Blepharitis
• Conjunctival scarring
• Graft edges
• Early recurrence

The final appearance should generally be judged after healing has progressed rather than during the first few weeks.

Will Surgery Correct My Astigmatism?

It may reduce pterygium-induced astigmatism.

The amount of improvement depends on:

• Pterygium size
• Corneal extension
• Duration
• Degree of corneal distortion
• Existing natural astigmatism
• Corneal scarring

Surgery does not necessarily eliminate all astigmatism because part of the prescription may be unrelated to the pterygium.

A new spectacle prescription should usually be delayed until corneal measurements become sufficiently stable.

Can the Cornea Remain Scarred After Removal?

Yes.

A longstanding pterygium may leave:

• A superficial opacity
• Iron deposition
• Irregularity
• Residual thinning
• Permanent corneal scarring

Removing the pterygium prevents further coverage and may improve corneal shape, but it cannot always restore completely transparent corneal tissue.

This is one reason surgery may be considered before a progressive lesion reaches the central visual axis.

Can Pterygium Return After Successful Surgery?

Yes.

No technique guarantees zero recurrence.

However, recurrence risk is considerably lower with modern conjunctival or limbal-conjunctival autografting than with simple bare-sclera excision.

Published recurrence rates vary because studies use different techniques, populations, definitions and follow-up durations.

Can Both Eyes Be Operated on Together?

Bilateral surgery may be considered, but many surgeons operate on one eye at a time.

Staged surgery allows:

• One eye to remain more comfortable during recovery
• Assessment of healing and recurrence tendency
• Easier use of postoperative drops
• Reduced functional inconvenience if both eyes become painful or light-sensitive

The decision depends on disease severity, lifestyle, anaesthetic arrangements and surgeon preference.

Can Double-Headed Pterygium Be Removed?

Yes.

A double-headed pterygium involves both the nasal and temporal sides of the same eye.

Surgery may be more complex because:

• A larger ocular-surface area is involved.
• More graft tissue is needed.
• Preserving healthy conjunctiva becomes important.
• Future glaucoma surgery may need to be considered.
• Recurrence and scarring risks may be higher.

Options may include:

• Two conjunctival grafts
• A divided graft
• Conjunctival rotation
• Amniotic membrane
• Other ocular-surface reconstruction techniques

The surgical plan should be individualised.

Can Pterygium Affect Glaucoma Surgery?

Yes.

Trabeculectomy and some glaucoma procedures require healthy superior conjunctiva.

When pterygium surgery is planned in a patient who has glaucoma or may require future glaucoma surgery, the surgeon should consider:

• Where graft tissue is harvested
• Preserving superior conjunctiva
• Previous conjunctival scarring
• Alternative graft materials

This may influence the choice of donor site or the use of amniotic membrane.

When Should a Pterygium Be Reviewed Earlier?

Arrange an earlier examination if you notice:

• Definite growth towards the centre
• Increasing blurred or distorted vision
• Rapidly changing astigmatism
• Persistent pain
• Atypical elevation or pigmentation
• Recurrent bleeding
• Restricted eye movement
• Double vision
• A new lesion in an unusual position
• Increasing contact-lens intolerance

A typical pterygium generally grows slowly. Rapid or unusual change warrants reassessment.

Warning Signs After Surgery

Contact the surgeon promptly for:

• Increasing pain
• Sudden reduction in vision
• Worsening redness after initial improvement
• Thick discharge
• Marked light sensitivity
• A white corneal spot
• Graft displacement or loss
• Significant bleeding
• Increasing eyelid swelling
• Headache or nausea with eye pain

These symptoms may indicate infection, surface breakdown, inflammation or raised eye pressure rather than ordinary healing.

Frequently Asked Questions

Is pterygium contagious?

No. It is not an infection and cannot be spread from person to person.

Can a pterygium become cancerous?

A typical pterygium is benign and does not normally transform into cancer.

However, a different ocular-surface lesion can occasionally resemble a pterygium. Atypical appearances may require biopsy or histopathology.

Can it disappear naturally?

No. An established pterygium does not usually disappear on its own.

Its redness may fluctuate, and a small pterygium may remain stable for years.

Can sunglasses shrink it?

No. Sunglasses do not remove existing tissue, but appropriate UV protection may reduce further environmental stimulation and help protect the ocular surface.

Can artificial tears stop its growth?

Artificial tears reduce dryness and irritation but have not been proven to stop or reverse pterygium growth.

Does every pterygium eventually reach the pupil?

No. Many remain small and stable.

Progression varies considerably between patients.

Is surgery urgent?

Most pterygium surgery is elective.

Earlier surgery may be advised when:

• The growth is progressing rapidly.
• Vision is being affected.
• The visual axis is threatened.
• Corneal measurements are becoming unreliable.
• Eye movement is restricted.
• The diagnosis is uncertain.

Will the operation affect my eyesight?

Vision may initially be blurred because of the healing corneal surface, inflammation and changing astigmatism.

Longer-term vision may improve if the pterygium was distorting the cornea.

Will I still need glasses?

Possibly.

Pterygium removal may reduce induced astigmatism but does not correct all myopia, hyperopia, presbyopia or natural astigmatism.

Can I wear contact lenses after surgery?

Yes, in many cases, once the surface has healed and the lens fit has been reassessed.

An old lens may no longer fit properly if the corneal shape has changed.

Can I exercise after surgery?

Light activity may be permitted relatively early, but strenuous exercise, swimming and contact sports are usually restricted temporarily.

Follow the surgeon’s instructions.

Can I fly after surgery?

Air travel is usually possible because pterygium surgery does not involve an intraocular gas bubble.

Comfort, follow-up timing and access to medical care should still be considered.

Why is my eye still red one month after surgery?

Ocular-surface healing can take several weeks or months.

Persistent redness may also reflect dry eye, allergy, sutures, inflammation, graft vessels or recurrence and should be assessed if it is worsening or troublesome.

Is glue better than stitches?

Glue often provides greater early comfort and shorter operating time. Recent pooled evidence suggests a recurrence advantage, while sutures may offer strong graft stability in selected situations.

The best method depends on the graft, ocular surface, available materials and surgeon experience.

Can recurrence be operated on again?

Yes.

Recurrent pterygium surgery is usually more complex and may require:

• A larger conjunctival or limbal graft
• Mitomycin C
• Amniotic membrane
• Removal of scar tissue
• Reconstruction around the eye muscles

The visual and cosmetic outcome depends on the extent of pre-existing scarring.

The Bottom Line

A pterygium is a benign, wing-shaped growth of conjunctival tissue that extends onto the cornea.

The main risk factor is cumulative ultraviolet exposure, with wind, dust, dry conditions, allergy and individual susceptibility also contributing.

A pterygium may cause:

• Redness
• Grittiness
• Dryness
• Contact-lens intolerance
• Increasing astigmatism
• Blurred or distorted vision
• Cosmetic concern

Small stable pterygia can usually be monitored with:

• Lubrication
• Allergy and dry-eye treatment
• Appropriate sunglasses
• A wide-brimmed hat
• Regular examinations

Surgery may be appropriate when the growth:

• Progresses
• Alters corneal shape
• Threatens the visual axis
• Causes persistent symptoms
• Restricts eye movement
• Interferes with cataract measurements
• Creates substantial cosmetic concern

Modern surgery generally involves removal of the pterygium followed by conjunctival or limbal-conjunctival autografting. This provides better recurrence control than leaving the sclera bare.

Surgery cannot guarantee a perfectly white eye or zero recurrence. Continued ultraviolet protection, control of inflammation and consistent postoperative care remain important.

A pterygium does not need to cover the pupil before it affects vision. Progressive growth, changing astigmatism or an atypical appearance should be assessed early.

References

1. National Eye Institute. Other Types of Corneal Disease: Pterygium. Updated December 2024.
   National Eye Institute
2. Shahraki T, et al. Pterygium: An Update on Pathophysiology, Clinical Features and Management. 2021.
   PubMed
3. Clearfield E, et al. Conjunctival Autograft for Pterygium. Cochrane Database of Systematic Reviews. 2016.
   PubMed
4. Clearfield E, et al. Conjunctival Autograft Versus Amniotic Membrane Transplantation: Findings From a Cochrane Review. 2017.
   PubMed
5. Noguera SI, et al. Clinical Outcomes of Pterygium Surgery Over a Ten-Year Period. 2025.
   PubMed Central
6. Jammal HM, et al. Long-Term Surgical Outcome of Pterygium Excision and Conjunctival Limbal Autograft. 2025.
   PubMed
7. Yoon CH, et al. Effect of Pterygium on Corneal Astigmatism, Irregularity and Higher-Order Aberrations. Scientific Reports. 2023.
   Nature
8. Kim S, et al. Optimal Time for Stabilisation of Anterior Corneal Keratometry After Primary Pterygium Excision. Korean Journal of Ophthalmology. 2026.
   PubMed
9. Terres MT, et al. Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review and Network Meta-Analysis. 2026.
   PubMed
10. Crespo MA, et al. Applications of Mitomycin C in Cornea and External Disease. 2023.
    PubMed