PTERYGIUM

SHORT CASE
DR. ANUJ MEHTA
DR. YAMINI SAHU
WHAT IS THIS?
 DEFINITION
Derived from Greek word “Pterygos” meaning small wing .
 Also known as Surfer’s eye or farmer’s eye.
 It is a non-malignant slow growing proliferation of wing shaped
fibrovascular tissue.
 Arises from subconjunctival tissue.
May extend over the cornea thus disturbing the vision.
 ETIOPATHOGENESIS
 Strong association between UV light exposure and formation of pterygium.
UV light may induce hyperplasia in limbal cells.
 These altered cells invade the cornea and limbus which moves centripetally with
them.
 More common in outdoor workers and welders.
 Also more common in warm dry climate.
Male:female is 2:1
WHY IS IT MORE COMMON NASALLY?
• ALBEDO HYPOTHESIS
 Light entering the temporal limbus at 90 degree is concentrated at nasal limbus (supported
and demonstrated by Coroneo)
 Related to corneal curvature.
 This explains the predominance of nasal pterygium.

• Reflection of UV light from Nasal bridge on to Nasal conjunctiva

 WHAT ARE PARTS OF PTERYGIUM ?
• HEAD
• NECK
• BODY
• CAP
• STOCKER’S LINE
STOCKER’S LINE
•A golden-yellow iron line may be seen
•Deposition of Pigments
 SYMPTOMS
• ASYMPTOMATIC
• DISTURBED OCULAR SURFACE
Tear film abnormality leading to
 Irritation
 Foreign body sensation
 Redness

• CHANGE IN CORNEAL CURVATURE

• Astigmatism causing Diminution of vision
• LIMITATION OF MOVEMENT
• Double vision
 SIGNS
• DIMINUTION OF VISION
• LIMITATION OF MOVEMENT
• DIPLOPIA
• STAGE OF PTERYGIUM
 STAGES

STAGE III
STAGE I

STAGE V

STAGE II STAGE IV
 DIFFERENTIAL DIAGNOSIS
1. PSEUDO PTERYGIUM
2. PINGUECULA
3. OCULAR SURFACE SQUAMOUS NEOPLASMS
4. LIMBAL DERMOID
PTERYGIUM VS PSEUDO PTERYGIUM
PTERYGIUM VS PINGUECULA
 OSSN
• Differentiating features
• Location
• Shape
• Feeder Vessel
• Intrinsic Vascularisation
• KERATIN DEPOSITS
 PTERYGIUM VS LIMBAL DERMOID

• Differentiating features
• Congenital
• Solid
• Raised
• Hair Follicles
• Fixed
 TREATMENT

• CONSERVATIVE
• Stage I to Stage 3
• Lubricants
• Protection from UV exposure
• SURGICAL
 WHAT ARE INDICATIONS FOR SURGICAL
TREATMENT ?

1. COSMETIC : Most common indication

Stage 2 onwards

2. DIMINUTION OF VISION
Encroaching the visual axis
Induced Astigmatism

3. DIPLOPIA/LIMITATION OF MOVEMENT
Usually thick fibrous pterygium
 SURGICAL TECHNIQUES
• BARE SCLERA TECHNIQUE
• CONJUNCTIVAL FLAP
• CONJUNCTIVAL AUTOGRAFT WITH LIMBAL STEM CELLS
• P.E.R.F.E.C.T SURGERY usually for recurrent pterygium
• With Sutures
• With fibrin Glue
• AMNIOTIC MEMBRANE TRANSPLANTATION
 ADJUNCTIVE TREATMENTS TO
PREVENT RECURRENCES
• RADIATION
• Beta Radiation
• Strontium 90
• MITOMYCIN C
• Intra operative
• Post operative drops
• OTHER ANTI MITOTIC AGENTS
• Doxorubicin
• 5 FU
 SURGICAL STEPS
• Pre operative preparation
• Steps of surgery
• Post operative care

•YouTube videos
• Pterygium surgery with conjunctival autograft by Dr Rajesh Fogla
• Pterygium surgery My technique by Dr Brain Kim
 COMPLICATIONS
• RECURRENCES: Most dreaded complication
• Use of various grafts
• Antimitotic agents
• Radiation
• MEDIAL RECTUS INJURY
• HAEMORRAGE
• CORNEAL/SCLERAL PERFORATION
• CORNEAL SCARRING
• GRAFT DISLOCATION/REJECTION
• PYOGENIC GRANULOMA
• SCLERAL NECROSIS