Pterygium: Symptoms, Causes, Surgery and Prevention

Author: Dr Val Phua
Estimated reading time: 20 minutes

A pterygium is a raised, triangular or wing-shaped growth of conjunctival tissue that extends from the white part of the eye onto the cornea—the clear front surface of the eye.

The plural of pterygium is pterygia.

A pterygium commonly develops on the nasal side of the eye, closest to the nose, although it may occasionally arise on the outer side or on both sides of the cornea.

It may appear:

• White, pink or reddish
• Thin and translucent
• Thick and fleshy
• Flat or raised
• Associated with visible blood vessels
• Present in one eye or both eyes

Most pterygia are benign and grow slowly. Some remain small for many years and cause few symptoms.

Others may become repeatedly inflamed or gradually extend farther onto the cornea, causing:

• Redness
• Burning
• Grittiness
• A foreign-body sensation
• Watery eyes
• Dry-eye symptoms
• Contact-lens discomfort
• Astigmatism
• Blurred or distorted vision
• Cosmetic concern

Long-term ultraviolet exposure is the strongest established environmental risk factor. Outdoor work, dry or dusty conditions and chronic ocular-surface irritation may also contribute.

Eyedrops may relieve irritation and inflammation, but they do not remove the growth.

Surgery is considered when the pterygium:

• Progresses towards the visual axis
• Causes significant astigmatism or blurred vision
• Produces persistent symptoms despite treatment
• Interferes with contact lenses
• Restricts eye movement
• Is cosmetically unacceptable to the patient
• Has features that make the diagnosis uncertain

Modern surgery usually removes the pterygium and covers the exposed area with healthy conjunctival tissue. Evidence strongly supports conjunctival autografting over bare-sclera excision because it produces a substantially lower risk of recurrence.

The Quick Answer

What Is a Pterygium?

A pterygium is a fibrovascular growth arising from the conjunctiva and extending across the limbus onto the cornea.

The limbus is the border between:

• The white sclera and conjunctiva
• The clear cornea

A typical pterygium has:

• A body on the white part of the eye
• A neck near the limbus
• A head advancing onto the cornea

The name comes from a Greek word meaning “wing,” reflecting its triangular appearance.

Is a Pterygium Cancer?

A typical pterygium is benign.

It does not normally:

• Spread to other parts of the body
• Invade deep into the eye
• Behave like an aggressive cancer

However, some ocular-surface tumours can resemble a pterygium. Recent pooled evidence suggests that a small proportion of tissue thought clinically to be pterygium may contain unsuspected ocular-surface squamous neoplasia, although the certainty of this estimate is limited. Atypical or excised tissue may therefore be sent for histopathological examination.

Can a Pterygium Affect Vision?

Yes.

It may affect vision by:

• Distorting the corneal shape
• Inducing astigmatism
• Disrupting the tear film
• Scarring the cornea
• Growing towards or over the pupil
• Preventing a contact lens from fitting properly

A pterygium can cause visually significant corneal distortion before it reaches the centre of the pupil.

Can Eyedrops Make It Disappear?

No.

Lubricating and anti-inflammatory drops may reduce:

• Dryness
• Burning
• Redness
• Irritation

They do not permanently shrink or remove the fibrovascular tissue.

Does Every Pterygium Need Surgery?

No.

Observation is appropriate when the pterygium:

• Is small
• Is stable
• Causes minimal symptoms
• Does not significantly distort the cornea
• Does not threaten the visual axis
• Is not cosmetically troublesome

Regular photographs, measurements, refraction or corneal imaging may be used to determine whether it is growing.

Can a Pterygium Return After Surgery?

Yes.

Recurrence is the principal challenge following pterygium surgery.

The risk depends on:

• Surgical technique
• Patient age
• Biological activity of the lesion
• Previous recurrence
• Continued ultraviolet exposure
• Postoperative inflammation
• Graft position and stability
• Use of selected anti-scarring treatment

Conjunctival autografting and appropriate fixation substantially reduce recurrence compared with leaving bare sclera exposed.

Understanding the Ocular Surface

The Conjunctiva

The conjunctiva is a thin transparent membrane covering:

• The white part of the eye
• The inner surfaces of the eyelids

It contains:

• Blood vessels
• Immune cells
• Mucin-producing cells
• Connective tissue

A pterygium originates within this surface tissue.

The Cornea

The cornea is the transparent window at the front of the eye.

It contributes most of the eye’s focusing power and must remain:

• Clear
• Smooth
• Regularly curved
• Covered by a stable tear film

When a pterygium pulls on or grows across the cornea, the corneal curvature may become irregular.

The Limbus

The limbus separates the cornea from the conjunctiva.

It contains limbal stem cells that help renew the corneal epithelium.

Pterygium development appears to involve a combination of:

• Ultraviolet-related limbal damage
• Abnormal tissue growth
• Inflammation
• Blood-vessel formation
• Fibroblast activity
• Remodelling of the extracellular matrix

The condition is therefore more complex than a simple fold of excess skin.

What Does a Pterygium Look Like?

A Triangular Growth

The typical lesion points towards the centre of the cornea.

It may have:

• A translucent leading edge
• A thicker pink body
• Prominent fine blood vessels
• Surrounding redness
• A smooth or slightly elevated surface

Nasal Pterygium

Most pterygia arise on the side nearest the nose.

One proposed explanation is that peripheral sunlight passing through the cornea may become focused towards the nasal limbus, increasing local ultraviolet exposure.

Temporal Pterygium

A growth on the outer side of the eye is less common.

A purely temporal or atypically shaped lesion should be examined carefully to confirm the diagnosis.

Double-Headed Pterygium

A patient may have growths on both the nasal and temporal sides of the same eye.

Surgical planning may be more complex because a larger conjunctival area may be required for grafting.

Bilateral Pterygia

Both eyes may be affected, but the extent may differ considerably.

Symptoms of Pterygium

No Symptoms

A small pterygium may be discovered during a routine eye examination.

Redness

The growth may appear more red:

• After sunlight exposure
• In dry weather
• In air conditioning
• After prolonged screen use
• During allergy
• When the ocular surface is inflamed

Foreign-Body Sensation

Patients may describe:

• Sand in the eye
• An eyelash rubbing
• A scratchy sensation
• Awareness of a raised area during blinking

Burning or Stinging

Burning may reflect:

• Surface inflammation
• Tear-film instability
• Dry eye
• Environmental exposure

Watery Eyes

Irritation may trigger reflex tearing.

Dry-Eye Symptoms

The raised tissue may interfere with:

• Smooth tear-film distribution
• Normal blinking
• Tear stability
• Contact-lens movement

A pterygium may coexist with meibomian gland dysfunction or other forms of dry-eye disease.

Intermittent Blurred Vision

Blur may fluctuate because of an irregular tear film.

Vision may temporarily improve after:

• Blinking
• Lubricating drops
• Resting the eyes

Astigmatism

A growing pterygium may flatten or distort the adjacent cornea.

This can cause:

• Increasing cylinder prescription
• Changing astigmatic axis
• Ghosting
• Distorted vision
• Reduced spectacle-corrected vision

Reduced Vision

Advanced visual impairment may occur when the lesion:

• Produces significant irregular astigmatism
• Scars the central cornea
• Approaches the visual axis
• Covers part of the pupil

Contact-Lens Discomfort

A contact lens may:

• Rub against the raised tissue
• Become unstable
• Decentre
• Cause greater redness
• Become difficult to tolerate

Cosmetic Concern

Some patients seek treatment because the eye appears:

• Persistently red
• Asymmetrical
• Fleshy
• Bloodshot
• Noticeably different from the other eye

Cosmetic concern is a legitimate factor in shared decision-making, provided the potential for postoperative redness, scarring and recurrence is understood.

Pterygium Versus Pinguecula

What Is a Pinguecula?

A pinguecula is a yellowish or whitish raised area on the conjunctiva near the cornea.

It does not cross onto the corneal surface.

What Is a Pterygium?

A pterygium extends across the limbus and onto the cornea.

Feature	Pinguecula	Pterygium
Location	Conjunctiva only	Conjunctiva extending onto cornea
Shape	Rounded or irregular bump	Triangular or wing-shaped
Corneal involvement	No	Yes
Effect on astigmatism	Usually minimal	May distort the cornea
Can approach visual axis	No	Yes
Surgery	Rarely required	May be required if progressive or symptomatic

Both conditions are associated with environmental exposure and may become inflamed.

Pterygium Versus Other Eye Growths

Ocular-Surface Squamous Neoplasia

Ocular-surface squamous neoplasia, or OSSN, may appear as:

• A gelatinous growth
• A leukoplakic or white plaque
• An irregular elevated lesion
• A vascular lesion near the limbus
• A growth extending onto the cornea

Possible suspicious features include:

• Rapid growth
• Irregular or nodular surface
• Unusual feeder blood vessels
• Thick white keratin
• Atypical location
• Recurrent bleeding
• Failure to resemble a classic triangular pterygium

Clinical appearance alone cannot always exclude neoplasia.

Conjunctival Papilloma

A papilloma may have:

• A frond-like surface
• A stalk
• Multiple fine vascular loops

Conjunctival Melanocytic Lesion

Pigmented lesions require assessment for:

• Colour
• Thickness
• Cysts
• Growth
• Abnormal blood vessels
• Corneal extension

Dermoid

A limbal dermoid is usually congenital and often appears as a pale raised lesion containing skin-like tissue.

Pseudopterygium

A pseudopterygium is an adhesion of conjunctiva to the cornea caused by:

• Trauma
• Chemical injury
• Inflammation
• Previous infection

Unlike a typical pterygium, it may occur at any position around the cornea.

What Causes a Pterygium?

Ultraviolet Radiation

Cumulative ultraviolet exposure is the strongest recognised risk factor.

Pterygium is more common among:

• People living nearer the equator
• Outdoor workers
• People with prolonged sunlight exposure
• Individuals who do not use suitable eye protection

Systematic reviews consistently identify sunlight and UV exposure as major contributors.

Outdoor Occupation

Occupations involving prolonged outdoor work may include:

• Construction
• Agriculture
• Fishing
• Landscaping
• Sports instruction
• Delivery work
• Military or maritime work

Risk reflects cumulative exposure rather than one isolated episode.

Wind and Dry Environments

Wind may increase:

• Tear evaporation
• Surface irritation
• Dust exposure
• Chronic inflammation

Dust, Sand and Smoke

Long-term exposure to airborne irritants may contribute to ocular-surface stress.

Increasing Age

Prevalence generally increases with age because cumulative environmental exposure increases over time.

Male Sex

Population studies have often reported a higher prevalence in men, potentially reflecting historical differences in outdoor occupational exposure.

Rural Residence

Some studies identify increased prevalence in rural communities, where outdoor and environmental exposure may be greater.

Genetic Susceptibility

Not everyone with substantial sunlight exposure develops a pterygium.

Genetic and cellular susceptibility probably contribute, although inheritance is not usually straightforward.

Dry-Eye and Ocular-Surface Disease

Tear-film instability may aggravate symptoms and inflammation, although it may not be the sole cause of the growth.

Can Pterygium Be Prevented?

Prevention Cannot Be Guaranteed

A pterygium may still develop despite reasonable protection.

However, reducing cumulative exposure is sensible and may reduce the risk of development, progression or recurrence.

Wear UV-Protective Sunglasses

Choose sunglasses that provide reliable ultraviolet protection.

Large or wraparound frames may reduce light entering from the side.

Dark tint alone does not confirm adequate UV protection.

Wear a Wide-Brimmed Hat

A suitable hat reduces direct sunlight reaching the eyes.

Use Protection During Outdoor Work

Consider:

• UV-protective safety glasses
• Dust protection
• Side shields
• Occupational eye protection

Reduce Eye Rubbing

Rubbing may worsen:

• Redness
• Inflammation
• Surface irritation

Treat Dry Eye and Allergy

Managing associated ocular-surface disease may reduce symptoms and repeated inflammation.

How Is Pterygium Diagnosed?

Clinical History

The ophthalmologist may ask:

• How long the growth has been present
• Whether it is enlarging
• Whether it becomes repeatedly red
• Whether vision has changed
• Whether the patient works outdoors
• Whether contact lenses are worn
• Whether surgery has been performed before
• Whether the lesion has bled or changed rapidly

Visual-Acuity Testing

Vision is tested with current correction and after refraction.

Refraction

Refraction measures:

• Short-sightedness
• Long-sightedness
• Astigmatism
• Corrected visual acuity

Changing or irregular astigmatism may support surgical consideration.

Slit-Lamp Examination

The slit lamp allows assessment of:

• Location
• Size
• Thickness
• Vascularity
• Corneal extension
• Surface regularity
• Inflammation
• Corneal scarring
• Suspicious features

Measuring the Pterygium

The ophthalmologist may record:

• Distance from the limbus to the head
• Width at the limbus
• Proximity to the pupil
• Progression compared with previous photographs
• Degree of vascularity or fleshiness

Photography

Serial photographs can document:

• Enlargement
• Increasing vascularity
• Recurrence after surgery
• Changes requiring further assessment

Corneal Topography or Tomography

Corneal imaging may be useful when:

• Astigmatism is increasing
• Vision is blurred
• Cataract surgery is planned
• A toric intraocular lens is being considered
• Irregular corneal shape is suspected
• The pterygium is relatively large

Imaging may demonstrate:

• Local corneal flattening
• Asymmetric astigmatism
• Irregularity
• Change after surgery

Tear-Film Assessment

Dry-eye testing may assess:

• Tear stability
• Corneal staining
• Meibomian gland function
• Eyelid disease

Anterior-Segment OCT

Anterior-segment OCT may help demonstrate:

• Tissue thickness
• Corneal extension
• Plane of the lesion
• Features that distinguish a typical pterygium from selected ocular-surface abnormalities

Histopathological Examination

Excised tissue may be sent to a laboratory for microscopic examination.

This is especially important when the lesion is:

• Atypical
• Recurrent
• Rapidly growing
• Unusually thick
• Associated with leukoplakia
• Located atypically
• Clinically uncertain

Grading Pterygium

Size-Based Grading

One method classifies the lesion according to how far it extends towards the pupil.

For example:

• Limited to the limbus
• Extending between the limbus and pupil
• Approaching the pupil margin
• Crossing the pupil area

Tissue Appearance

The pterygium may be described as:

• Atrophic and translucent
• Intermediate
• Fleshy and opaque

A fleshy, highly vascular lesion may have greater biological activity and recurrence risk.

Grading Does Not Dictate Surgery Alone

The decision also considers:

• Symptoms
• Growth
• Vision
• Astigmatism
• Patient age
• Cosmetic concern
• Contact-lens use
• Planned eye surgery
• Diagnostic uncertainty

Non-Surgical Treatment

Observation

A small stable lesion can be monitored.

Protection from ultraviolet exposure remains important.

Artificial Tears

Lubricants may help:

• Grittiness
• Burning
• Intermittent blur
• Foreign-body sensation
• Reflex watering

Preservative-free products may be preferable when used frequently.

Lubricating Gel or Ointment

Thicker formulations may help when symptoms are worse at night or on waking.

They can temporarily blur vision.

Short-Course Anti-Inflammatory Drops

A clinician may prescribe a short course of anti-inflammatory medication when the pterygium becomes significantly inflamed.

Possible options include:

• A mild topical corticosteroid
• Another anti-inflammatory drop

Steroids require supervision because they may:

• Raise eye pressure
• Accelerate cataract formation
• Mask infection
• Worsen herpes or fungal disease

Allergy Treatment

Anti-allergy drops may be useful when itching and allergy coexist.

Vasoconstrictor Drops

“Get-the-red-out” drops do not treat the pterygium.

Frequent use may cause:

• Rebound redness
• Irritation
• Dependence on repeated use
• Masking of another condition

When Is Surgery Considered?

Progressive Growth

Documented extension towards the visual axis is an important indication.

Visual-Axis Threat

Surgery is generally recommended before the lesion permanently scars or covers the central optical zone.

Induced Astigmatism

Surgery may be considered when the pterygium causes:

• Increasing cylinder
• Irregular astigmatism
• Ghosting
• Reduced corrected vision

Persistent Irritation

Symptoms may justify surgery when they remain troublesome despite:

• Lubricants
• Environmental protection
• Treatment of dry eye
• Control of allergy or inflammation

Recurrent Inflammation

Repeated painful or markedly red episodes may affect comfort and quality of life.

Contact-Lens Intolerance

A raised lesion may prevent safe and comfortable lens fitting.

Restricted Eye Movement

A large or recurrent pterygium may scar the conjunctiva and restrict movement, occasionally causing double vision.

Cosmetic Concern

Surgery may be considered when the appearance causes significant distress.

The patient should understand that the eye may remain red for weeks and that surgery cannot guarantee a perfectly white appearance.

Diagnostic Uncertainty

Excision may be recommended when the lesion has suspicious or atypical features.

Why Simple Removal Is Not Enough

Bare-Sclera Excision

Bare-sclera surgery removes the pterygium but leaves the underlying sclera uncovered.

This technique is associated with an unacceptably high recurrence risk and is generally avoided as a standalone procedure.

Why Recurrence Happens

Surgery itself triggers:

• Wound healing
• Fibroblast activity
• Blood-vessel growth
• Inflammation

Without appropriate surface reconstruction, the regrowth may become:

• Thicker
• Redder
• More aggressive
• More scarred

Conjunctival Autograft Surgery

What Is a Conjunctival Autograft?

After removing the pterygium, the surgeon takes a thin piece of healthy conjunctiva—usually from beneath the upper eyelid—and transfers it to the exposed area.

The graft:

• Covers the bare sclera
• Restores a healthier surface
• Acts as a barrier to regrowth
• Reduces recurrence

Modern evidence supports conjunctival autograft as the preferred approach for most primary pterygium surgery.

Limbal-Conjunctival Autograft

The graft may include a small amount of limbal tissue.

The purpose is to restore a limbal barrier and potentially further reduce recurrence.

Care is required to avoid damaging healthy donor-site stem cells.

Where Is the Graft Taken From?

The graft is usually harvested from the superior or superotemporal conjunctiva under the upper eyelid.

This area is generally hidden in ordinary gaze.

What Happens to the Donor Site?

The donor area usually heals naturally.

It may initially be:

• Red
• Sore
• Slightly swollen

How Is the Graft Secured?

Fibrin Glue

Medical fibrin adhesive can secure the graft without traditional sutures.

Potential advantages include:

• Shorter surgery
• Less postoperative discomfort
• Less early inflammation
• Lower or comparable recurrence in many studies

Recent evidence syntheses identify fibrin glue as having a favourable profile for recurrence and patient comfort, although cost, availability and rare blood-product-related concerns may influence its use.

Sutures

Absorbable or non-absorbable sutures may be used.

Advantages include:

• Secure mechanical fixation
• Availability without tissue adhesive
• Familiarity in complex grafts

Possible disadvantages include:

• Greater foreign-body sensation
• More inflammation
• Longer operating time
• Suture granuloma
• Need for removal in selected cases

Autologous Blood

The patient’s own blood may be used to help the graft adhere without commercial glue or multiple sutures.

This avoids adhesive cost but may have a greater risk of:

• Graft movement
• Retraction
• Loss
• Folding

Fixation should be individualised according to lesion complexity, graft stability and surgeon experience.

Amniotic-Membrane Grafting

What Is Amniotic Membrane?

Amniotic membrane is donated biological tissue prepared for medical use.

It may support:

• Surface healing
• Reduced inflammation
• Reconstruction of large defects

When May It Be Used?

It may be considered when:

• The conjunctival defect is large
• Both nasal and temporal lesions are treated
• Conjunctiva must be preserved for possible glaucoma surgery
• A recurrent lesion has caused significant scarring
• The ocular surface requires broader reconstruction

Does It Have the Same Recurrence Risk?

For many primary pterygia, conjunctival autograft generally has a lower recurrence risk than amniotic membrane alone.

Amniotic membrane remains useful in selected complex cases where preserving or obtaining conjunctiva is important.

Mitomycin C

What Is Mitomycin C?

Mitomycin C is an anti-proliferative medication that inhibits fibroblast activity.

It may be applied during surgery in selected cases to reduce recurrence.

When May It Be Considered?

Possible situations include:

• Recurrent pterygium
• Young patient with aggressive tissue
• Large fleshy lesion
• Significant conjunctival scarring
• High estimated recurrence risk

Why Is It Used Carefully?

Mitomycin C can cause serious complications if the concentration, exposure or tissue coverage is inappropriate.

Potential problems include:

• Delayed epithelial healing
• Scleral thinning
• Scleral necrosis or melting
• Infection
• Inflammation
• Glaucoma
• Cataract
• Corneal or intraocular toxicity

It should be used selectively and followed by adequate tissue coverage.

Other Anti-Recurrence Measures

Meticulous Tissue Removal

Removal of abnormal fibrovascular tissue while preserving healthy structures is important.

Healthy Graft Placement

The graft should be:

• Correctly oriented
• Thin
• Well positioned
• Stable
• Covering the intended area

Control of Postoperative Inflammation

Anti-inflammatory treatment and follow-up may reduce excessive wound-healing activity.

Ultraviolet Protection

Continued UV exposure may contribute to recurrence risk.

Other Adjuncts

Selected surgeons may use other anti-scarring agents or techniques in difficult recurrent cases.

Evidence and safety vary, and these approaches should not be considered routine for every patient.

What Happens During Pterygium Surgery?

Before Surgery

The clinical team may:

• Confirm the correct eye
• Review medication
• Measure vision
• Examine the lesion
• Obtain consent
• Apply anaesthetic drops
• Clean the eyelids and ocular surface

Anaesthesia

Most surgery is performed using:

• Numbing eyedrops
• Local anaesthetic injection
• Sedation when required

The patient is usually awake.

Removal of the Growth

The surgeon carefully separates the pterygium from:

• The cornea
• The sclera
• Surrounding conjunctiva

The corneal surface may be smoothed.

Graft Preparation

A thin conjunctival graft is harvested and positioned over the exposed sclera.

Graft Fixation

The graft is secured using:

• Fibrin glue
• Sutures
• Autologous blood
• A combination

Completion

The surgeon checks:

• Graft position
• Haemostasis
• Corneal surface
• Eyelid movement

Ointment and an eye pad or shield may be applied.

How Long Does Surgery Take?

The duration depends on:

• Size
• Primary or recurrent disease
• Degree of scarring
• Number of lesions
• Graft technique
• Fixation method
• Additional reconstruction

The total clinic or surgical-centre visit is longer than the operation because of preparation and recovery.

Is Pterygium Surgery Painful?

During surgery, the patient may feel:

• Pressure
• Touch
• Movement
• Fluid around the eye

Sharp pain should not be expected after adequate anaesthesia.

As the anaesthetic wears off, the eye may feel significantly:

• Gritty
• Sore
• Watery
• Light-sensitive

The first few days are usually the most uncomfortable.

Recovery After Surgery

The First Day

The eye may be:

• Red
• Watery
• Sore
• Light-sensitive
• Blurred
• Difficult to open comfortably

The First Week

Symptoms commonly include:

• Foreign-body sensation
• Eyelid swelling
• Blood beneath the conjunctiva
• Awareness of sutures if used
• Fluctuating blur
• Sticky ointment

The First Few Weeks

The graft gradually settles.

Redness may remain prominent even when healing is proceeding normally.

Several Weeks to Months

Cosmetic whitening continues gradually.

The final appearance should not be judged during the first few postoperative weeks.

Postoperative Medication

Medication may include:

• Antibiotic drops
• Steroid drops
• Lubricating drops
• Antibiotic ointment
• Another anti-inflammatory preparation

Follow the prescribed taper carefully.

Stopping anti-inflammatory drops too early may allow rebound inflammation, while prolonged unsupervised steroid use may raise eye pressure.

Activity After Surgery

Do Not Rub the Eye

Rubbing may:

• Displace the graft
• Cause bleeding
• Introduce infection
• Delay healing

Eye Shield

A protective shield may be advised during sleep for the first few nights.

Washing and Showering

Avoid getting soap, shampoo or dirty water directly into the operated eye during early healing.

Swimming

Swimming should be avoided until the ocular surface has healed and the surgeon confirms that it is safe.

Exercise

Light activity may resume according to the surgeon’s advice.

Avoid:

• Heavy straining
• Contact sports
• Dusty environments
• Activities risking direct eye trauma

during early recovery.

Eye Makeup

Avoid eye makeup until healing is adequate and the clinical team permits it.

Contact Lenses

Do not resume contact lenses until the corneal surface and graft are stable.

Driving

Do not drive when:

• Vision is blurred
• The eye is patched
• Depth perception is impaired
• Medication affects vision
• The surgeon has not cleared driving

What Is Normal After Surgery?

Common temporary findings include:

• Redness
• Grittiness
• Watering
• Mild to moderate soreness
• Light sensitivity
• Blurred vision
• Blood under the conjunctiva
• Eyelid swelling
• Awareness of sutures
• A visible edge of the graft

These should generally improve rather than progressively worsen.

Warning Signs After Surgery

Seek urgent assessment for:

• Increasing or severe pain
• Sudden visual deterioration
• Increasing redness after initial improvement
• Thick discharge
• Significant eyelid swelling
• Marked light sensitivity
• Trauma to the eye
• A displaced, folded or missing graft
• Nausea or vomiting with eye pain
• A new white corneal spot

Possible causes include:

• Infection
• Raised eye pressure
• Graft displacement
• Corneal epithelial defect
• Significant inflammation
• Scleral or corneal complication

How Does Surgery Affect Vision?

Astigmatism May Improve

Removal may allow the cornea to become:

• Less flattened
• More symmetrical
• Less irregular

Vision May Initially Worsen

Early blur may result from:

• Surface healing
• Tear-film instability
• Corneal irregularity
• Medication
• Graft swelling
• Pupil dilation

Final Refraction Should Be Delayed

A definitive spectacle prescription is generally measured after the corneal surface has stabilised.

The appropriate interval depends on:

• Pterygium size
• Degree of preoperative distortion
• Healing
• Planned cataract or refractive surgery

Corneal Scarring May Remain

A large or long-standing pterygium can leave:

• Corneal haze
• Iron deposition
• Stromal scarring
• Residual irregular astigmatism

Removing the growth does not always restore a completely normal cornea.

Recurrence After Surgery

What Is Recurrence?

Recurrence means new fibrovascular tissue grows back across the limbus onto the cornea.

Postoperative redness alone is not necessarily recurrence.

When Does Recurrence Occur?

Most clinically important recurrence becomes evident during the first several postoperative months, although later recurrence is possible.

What Does It Look Like?

Possible signs include:

• Increasing blood vessels
• Thickening near the graft edge
• A fleshy triangular regrowth
• Extension back onto the cornea
• Increasing redness
• Return of astigmatism

Risk Factors for Recurrence

Risk may be increased by:

• Young age
• Fleshy or aggressive lesion
• Previous recurrence
• Significant inflammation
• Bare-sclera technique
• Poor graft fixation
• Graft retraction
• Continued UV exposure
• Genetic or individual wound-healing tendency

Can a Recurrent Pterygium Be Reoperated?

Yes.

Recurrent surgery may be more difficult because of:

• Scarring
• Restricted eye movement
• Reduced healthy conjunctiva
• Greater fibrovascular activity
• Attachment to the underlying muscles

Treatment may require:

• Larger conjunctival or limbal autograft
• Amniotic membrane
• Selected mitomycin C
• More extensive scar removal
• Complex ocular-surface reconstruction

Pterygium and Cataract Surgery

Why Does the Pterygium Matter?

A pterygium may alter:

• Keratometry
• Corneal astigmatism
• Corneal topography
• Intraocular-lens calculations
• Toric-IOL planning

Which Operation Should Be Performed First?

A visually significant or sufficiently large pterygium is often removed before cataract surgery when it causes unstable or distorted corneal measurements.

The cornea is then allowed to stabilise before final biometry is repeated.

Can Both Procedures Be Combined?

Combined surgery is possible in selected cases.

Potential disadvantages include:

• Less predictable IOL calculation
• Changing astigmatism after pterygium removal
• More postoperative inflammation
• Difficulty determining the source of visual symptoms

Staged treatment often provides more reliable refractive planning when the pterygium meaningfully alters the cornea.

Toric Intraocular Lenses

A toric lens should be planned cautiously when pterygium-induced astigmatism may change after excision.

Stable repeated measurements are important.

Pterygium and Laser Vision Correction

LASIK or PRK Assessment

A pterygium may interfere with:

• Corneal topography
• Wavefront measurements
• Tear-film stability
• Laser planning
• Epithelial healing

A significant lesion is generally addressed before elective corneal refractive surgery.

Surgery Does Not Guarantee Laser Suitability

After removal, the patient still requires complete assessment for:

• Corneal thickness
• Corneal shape
• Dry eye
• Refractive stability
• Ectasia risk

Pterygium and Contact Lenses

Can Contact Lenses Be Worn?

A small quiet pterygium may not prevent contact-lens use.

However, lenses may cause:

• Mechanical rubbing
• Redness
• Poor fit
• Discomfort
• Greater dryness
• Lens instability

After Surgery

Contact lenses should not be resumed until:

• The epithelium has healed
• The graft is stable
• Inflammation is controlled
• The surgeon approves
• The lens fit is reassessed if necessary

Pterygium in Children and Young Adults

Pterygium is less common in children than adults.

A conjunctival or corneal growth in a child should be examined carefully because alternative diagnoses may be more likely.

When pterygium occurs in a young person, attention should be given to:

• Outdoor exposure
• UV protection
• Allergy
• Eye rubbing
• Growth rate
• Recurrence risk

Younger age may be associated with more active wound healing and a higher recurrence risk after surgery.

Pterygium During Pregnancy

A pterygium itself does not generally threaten pregnancy.

Management usually focuses on:

• Lubrication
• UV protection
• Avoiding irritants
• Pregnancy-appropriate medication

Elective surgery is often deferred unless there is a compelling clinical reason.

All medication should be reviewed with the ophthalmologist and obstetric clinician.

Can a Pterygium Cause Blindness?

A typical pterygium rarely causes complete blindness.

Severe visual impairment may occur when it:

• Covers the pupil
• Causes dense central corneal scarring
• Produces major irregular astigmatism
• Coexists with another eye disease

Earlier assessment is preferable before the central optical cornea is permanently scarred.

Common Myths

“A Pterygium Is a Cataract Growing Outside the Eye”

False.

A cataract is clouding of the natural lens inside the eye.

A pterygium is an ocular-surface growth extending onto the cornea.

“A Pterygium Is a Cancer”

A typical pterygium is benign.

Atypical lesions may need biopsy because some tumours can resemble pterygia.

“Eyedrops Can Dissolve It”

False.

Drops may relieve symptoms but cannot remove established tissue.

“Every Pterygium Must Be Removed”

False.

Small stable lesions may be safely monitored.

“Surgery Prevents It From Ever Returning”

False.

Modern graft techniques reduce recurrence but cannot eliminate the risk completely.

“Sunglasses Make an Existing Pterygium Disappear”

False.

UV protection may reduce irritation and future exposure but does not remove existing tissue.

“The Growth Must Reach the Pupil Before Surgery”

False.

Significant astigmatism and corneal distortion can occur before the lesion reaches the pupil.

“A Red Eye After Surgery Means the Pterygium Has Recurred”

False.

Postoperative redness is common and may take weeks or months to settle.

Frequently Asked Questions

How Fast Does a Pterygium Grow?

Growth varies.

It may:

• Remain unchanged for years
• Grow slowly
• Become more active after prolonged environmental exposure
• Progress more rapidly in selected younger patients

Serial photographs or measurements are more reliable than memory alone.

Can It Stop Growing?

Yes.

Some pterygia remain stable indefinitely.

Can It Shrink Naturally?

Inflammation and redness may reduce, making it appear smaller.

Established fibrovascular tissue does not usually disappear completely.

Why Is It Usually Near the Nose?

The nasal limbus may receive greater focused peripheral ultraviolet exposure because of the optical shape of the cornea.

Can It Occur on the Outer Side?

Yes, although temporal pterygia are less common.

An atypical temporal lesion should be examined carefully.

Can It Occur in Both Eyes?

Yes.

One eye may be more advanced.

Does It Cause Floaters?

No.

Floaters arise from the vitreous gel inside the eye.

Does It Cause Eye Pressure or Glaucoma?

A pterygium itself does not usually cause glaucoma.

Steroid drops used repeatedly for inflammation may raise IOP in susceptible patients.

Why Does It Become Red Sometimes?

Redness may increase with:

• UV exposure
• Dryness
• Wind
• Dust
• Allergy
• Eye rubbing
• Surface inflammation

Are Artificial Tears Safe?

Many lubricating drops can be used regularly.

Preservative-free products may be preferable for frequent use.

When Should I Consider Surgery?

Surgery may be appropriate for:

• Documented growth
• Astigmatism
• Blurred vision
• Visual-axis threat
• Persistent irritation
• Recurrent inflammation
• Contact-lens intolerance
• Significant cosmetic concern
• Diagnostic uncertainty

Will Surgery Make the Eye Completely White?

Not necessarily.

The final appearance depends on:

• Preoperative vascularity
• Scarring
• Healing response
• Recurrence
• Graft appearance
• Other conjunctival pigmentation or vessels

Will I Need General Anaesthesia?

Most adults undergo surgery with local anaesthesia.

General anaesthesia may be considered for selected children or patients unable to cooperate.

Will I Need Stitches?

Not always.

The graft may be secured with fibrin glue, sutures, autologous blood or a combination.

How Long Will the Eye Stay Red?

Prominent redness may persist for several weeks and continue gradually improving over several months.

When Can I Return to Work?

This depends on:

• Discomfort
• Visual requirements
• Work environment
• Dust exposure
• Cosmetic concern
• Whether sutures were used

Office work may be resumed relatively quickly, while outdoor, dusty or physically demanding work may require more time.

Will My Astigmatism Improve?

It often improves when the pterygium is responsible for corneal distortion.

Residual natural or irregular astigmatism may remain.

Can a Recurrent Pterygium Be More Aggressive?

Yes.

Recurrent tissue may be:

• More vascular
• More scarred
• More difficult to remove
• More likely to restrict movement

Should the Tissue Be Sent to the Laboratory?

Many surgeons send removed tissue for histopathological assessment, particularly when there are atypical or suspicious features.

When to Seek Urgent Eye Care

An uncomplicated pterygium usually does not require emergency treatment.

Seek urgent assessment for:

• Sudden loss of vision
• Severe eye pain
• Marked light sensitivity
• Thick discharge
• A white corneal spot
• Significant trauma
• Rapidly enlarging or bleeding tissue
• A new irregular or nodular surface growth
• Severe symptoms in a contact-lens wearer
• Increasing pain or redness after surgery
• Graft displacement after surgery

These symptoms may indicate:

• Corneal infection
• Uveitis
• Ocular-surface tumour
• Surgical complication
• Another eye disease

A Pterygium Assessment Checklist

Symptoms to Report

• Redness
• Burning
• Grittiness
• Watering
• Blurred vision
• Ghosting
• Increasing astigmatism
• Contact-lens discomfort
• Cosmetic concern
• Rapid change

Risk Factors

• Outdoor occupation
• Long-term sunlight exposure
• Living near the equator
• Wind and dust exposure
• Previous pterygium surgery
• Family tendency
• Dry eye or allergy

Tests That May Be Useful

• Visual acuity
• Refraction
• Slit-lamp examination
• Photography
• Pterygium measurements
• Corneal topography
• Corneal tomography
• Tear-film assessment
• Anterior-segment OCT
• Histopathology after removal

Questions to Ask

• Is the lesion definitely a pterygium?
• Has it grown?
• Is it causing astigmatism?
• Does it need surgery now?
• Which graft technique will be used?
• Will glue or sutures be used?
• Is mitomycin C necessary?
• Will the tissue be sent for laboratory examination?
• What is my recurrence risk?
• How long should I avoid swimming and exercise?
• When will the cornea be stable for new glasses?
• Should it be removed before cataract surgery?

The Bottom Line

A pterygium is a benign fibrovascular growth that extends from the conjunctiva onto the cornea.

It is strongly associated with cumulative ultraviolet exposure and is more common among people who:

• Live in sunny climates
• Work outdoors
• Experience chronic wind, dust or surface irritation

A pterygium may cause:

• Redness
• Burning
• Grittiness
• Watering
• Dry-eye symptoms
• Contact-lens intolerance
• Astigmatism
• Blurred or distorted vision

Small stable lesions can often be observed.

Eyedrops may relieve irritation but cannot remove the growth.

Surgery is considered when the pterygium:

• Progresses
• Threatens the visual axis
• Causes significant corneal distortion
• Produces persistent symptoms
• Interferes with contact lenses
• Causes cosmetic concern
• Has atypical features

The preferred modern operation generally involves:

• Careful removal of the pterygium
• Reconstruction using conjunctival or limbal-conjunctival autograft
• Fixation with fibrin glue, sutures or another appropriate method
• Selected use of anti-scarring medication in higher-risk cases

Recurrence remains possible.

The best long-term strategy combines:

• Appropriate surgery
• Control of postoperative inflammation
• Reliable follow-up
• UV-protective sunglasses
• A wide-brimmed hat
• Management of dry eye and allergy
• Avoidance of chronic environmental irritation

The most important principle is:

Do not wait until a pterygium covers the pupil before seeking assessment—corneal distortion and astigmatism may affect vision well before the growth reaches the centre.

References

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