Pterygium: Symptoms & Treatment

What is a pterygium?

A pterygium of the conjunctiva is a benign growth that is common in people with a lot of sun exposure. This is why it is also known as surfer’s eye. Other factors thought to contribute to a pterygium are dust and a dry atmosphere.

Page contents

1. What is a pterygium?
2. What are the symptoms of a pterygium?
3. How is a pterygium treated?
4. How much does treatment cost? Are prices affordable?
5. Why does a pterygium develop? The role of the sun
6. How is a pterygium removed, and does it come back?
7. Pterygium or pinguecula? How to tell them apart
8. Who is at higher risk
9. Stages of pterygium
10. How it affects vision
11. Diagnosis and monitoring
12. Eye drops: what they can and cannot do
13. Surgical removal in detail
14. Recovery after the procedure
15. Pterygium before laser or cataract surgery
16. Prevention: how to protect your eyes
17. Myths about pterygium
18. When is the right time for removal?
19. Pterygium and contact lenses
20. Returning to activities after removal
21. Pterygium in young people
22. Questions worth asking your ophthalmologist
23. Why a pterygium becomes red and irritated
24. Pterygium and appearance
25. After removal: how to prevent recurrence
26. How to tell if a pterygium is growing
27. Can it appear in both eyes?
28. Pterygium and driving
29. Frequently Asked Questions about Pterygium

It usually appears in the exposed area between the eyelids and spreads from the nose side towards the cornea (the clear tissue in front of the coloured part of the eye). It can, however, also grow in the opposite direction.

What are the symptoms of a pterygium?

Symptoms include frequent irritation and redness, a foreign body sensation, watering and itching. In advanced cases it can affect the cornea to such an extent that it also causes problems with vision.

How is a pterygium treated?

Treatment is only necessary if the symptoms cause problems in the patient’s daily life. It involves surgical removal of the entire lesion. With extensive lesions, a conjunctival autograft or an amniotic membrane graft may be needed to repair the defect left by removing the pterygium.

How much does treatment cost? Are prices affordable?

The cost of the procedure is affordable. However, for more information about prices, please contact the ophthalmologist.

Why does a pterygium develop? The role of the sun

The main factor behind a pterygium is chronic exposure to ultraviolet radiation. UV radiation damages the cells of the conjunctiva at the border with the cornea, mainly on the inner side of the eye, where light entering the eye from the side is concentrated.

A pterygium is more common in:

• people who live in sunny countries, such as Greece,
• people who work or spend many hours outdoors, such as farmers, fishermen, builders and water sports athletes,
• people often exposed to wind, dust and dry environments,
• people with dry eye, which further irritates the surface of the eye.

Protection is simple: sunglasses with certified UV protection and frames that also cover the sides, a hat with a brim, and lubricating drops in dry or windy conditions. The same measures reduce the chance of an existing pterygium growing or coming back after removal. You will find more tips in our article on protecting your eyes in summer.

How is a pterygium removed, and does it come back?

Removal is done under local anaesthetic and usually takes 30-45 minutes. The surgeon removes the pterygium from the cornea and conjunctiva and covers the area with a thin conjunctival graft from the same eye, usually from the upper part, under the eyelid. The graft is secured with a special tissue glue or with stitches. In some cases an amniotic membrane or medicines that limit scarring are used.

After the procedure:

• the eye stays covered until the following day,
• the foreign body sensation and watering last a few days,
• the redness fades gradually over a few weeks,
• eye drops follow for several weeks, as instructed.

A pterygium can come back, usually within the first year. The risk was high with the older technique of simple excision, but it is significantly lower with a conjunctival graft. Sticking to the treatment and protecting the eyes from the sun also help. Because a pterygium often causes astigmatism, the glasses prescription is checked again a few weeks after the procedure.

Pterygium or pinguecula? How to tell them apart

Two conditions of the conjunctiva are often confused. A pinguecula is a small, yellowish, slightly raised “cushion” on the white of the eye, usually on the side nearest the nose. It does not spread onto the cornea. A pterygium, on the other hand, is a triangular, fleshy tissue with blood vessels that starts in the conjunctiva and “climbs” onto the cornea, towards the centre of the eye.

Both are linked to ultraviolet radiation, wind and dust, and a pinguecula often comes before a pterygium. A pinguecula rarely needs surgery, whereas a pterygium can affect vision as it grows.

Who is at higher risk

• people who work or spend many hours outdoors, such as farmers, fishermen, builders, sailors and drivers
• people who live in very sunny areas, such as Greece, especially near the sea
• people who do water sports, skiing or sailing, where light is reflected off water and snow
• people with dry eye or chronic eye irritation
• people with a family history of pterygium

A pterygium usually appears between the ages of 20 and 50 and is slightly more common in men.

Stages of pterygium

• Early: the tissue just reaches the edge of the cornea. It often causes only redness and irritation.
• Intermediate: the pterygium grows onto the cornea and starts to cause astigmatism.
• Advanced: it approaches or covers the pupil, with a significant drop in vision.

Besides size, the “activity” of the pterygium also matters. A thick, red pterygium with many blood vessels usually grows faster than a thin, pale one.

How it affects vision

As the pterygium advances over the cornea, it “pulls” on it and changes its curvature. The result is astigmatism that increases gradually and cannot always be fully corrected with glasses. If the pterygium approaches the centre, it also directly blocks vision. That is why, during monitoring, we measure not only its size but also the corneal topography, so we can recommend removal before permanent distortion occurs.

Diagnosis and monitoring

The diagnosis is made by examination at the slit lamp. In the clinic we record the size of the pterygium in millimetres, its position, its blood vessels and its effect on vision. For many patients we take photographs and perform corneal topography, so that at each follow-up we can see objectively whether it is growing. When the appearance is atypical, for example an unusual white or gelatinous surface or a rapid change, the ophthalmologist will consider the possibility of a different conjunctival lesion and may recommend a histological examination at the time of removal.

Eye drops: what they can and cannot do

There are no eye drops that “dissolve” a pterygium. However, eye drops help a great deal with the symptoms:

• Artificial tears for irritation and the foreign body sensation, preferably preservative-free.
• Short-term anti-inflammatory eye drops when the pterygium is red and inflamed, only on a doctor’s advice.
• Avoiding vasoconstrictor drops “for red eyes”, which make the redness worse with frequent use.

Surgical removal in detail

The procedure is done in the operating theatre under local anaesthetic and takes about 30 to 45 minutes. The key point is not just removal but preventing recurrence:

1. the pterygium tissue is removed from the cornea and conjunctiva and the corneal surface is smoothed
2. a conjunctival autograft, a thin piece of healthy conjunctiva from the upper part of the same eye, is placed over the area
3. the graft is secured with a special biological tissue glue or with very fine stitches
4. in selected cases, an amniotic membrane or medicines that reduce the chance of recurrence are used

The autograft technique has significantly reduced recurrence rates compared with the simple excision used in the past.

Recovery after the procedure

• The first few days: a foreign body sensation, watering and redness are to be expected. Eye drops and painkillers make this period more comfortable.
• The first week: avoid rubbing the eye, dust, swimming and eye make-up. Most people return to office work within a few days.
• The following months: anti-inflammatory eye drops continue for several weeks and are tapered gradually, because inflammation is the main cause of recurrence. The redness at the graft site fades gradually.
• Long term: sun protection and follow-up visits, especially during the first year.

Pterygium before laser or cataract surgery

A pterygium that reaches the cornea distorts the measurements needed to calculate the intraocular lens for cataract surgery or to plan laser vision correction. In these cases we usually remove the pterygium first and, once the cornea has stabilised after a few weeks, take new measurements and schedule the second procedure. This makes the final visual result much more accurate.

Prevention: how to protect your eyes

• sunglasses with full UV400 protection and, ideally, wraparound coverage
• a hat with a brim during hours of strong sunshine
• protective glasses in dusty or windy workplaces
• artificial tears when the eyes are dry or irritated
• extra protection at the sea and in the snow, where reflection multiplies the radiation

For choosing the right sunglasses, you will find useful information in our article on sunglasses and eye protection.

Myths about pterygium

• “A pterygium is cancer.” A pterygium is a benign degeneration of the conjunctiva. It does, however, need to be seen by an ophthalmologist, because other lesions can occasionally look similar.
• “If I have it removed, it will definitely come back.” With modern techniques and proper aftercare, recurrence is far less common than it used to be.
• “A pterygium spreads from one eye to the other.” It is not contagious. It can appear in both eyes because both are exposed to the same factors.

Dr. Vasileios Skouteris examines, monitors and removes pterygia using modern techniques. To book an appointment at his clinic in Neo Psychiko, Athens, call 210 677 0007.

When is the right time for removal?

Not every pterygium needs surgery. The decision is based on specific criteria:

• the pterygium is approaching the pupil or has advanced several millimetres onto the cornea
• it causes increasing astigmatism or reduces vision
• it grows between successive follow-up visits
• it causes chronic irritation and redness that eye drops do not control
• it prevents the use of contact lenses
• cataract or laser surgery is being planned
• it is a significant cosmetic concern for the patient

For a small, quiet pterygium that is not changing, monitoring every 6 to 12 months and sun protection are usually enough.

Pterygium and contact lenses

Soft contact lenses can irritate a pterygium, especially when it is raised near the edge of the cornea. The edge of the lens rubs against the tissue, causing redness, intolerance and, in some patients, faster growth. If you wear contact lenses and have a pterygium, the lens fit needs to be checked and you may need to wear them for fewer hours. After pterygium removal, you can usually go back to contact lenses after a few weeks, once the graft has fully healed.

Returning to activities after removal

• Reading and television: from the next day, with breaks.
• Office work: usually after two to five days.
• Driving: when your vision is comfortable and the eye is not watering heavily, usually within the first week.
• Gym and running: after about a week, avoiding sweat getting into the eye.
• Swimming and the sea: after two to three weeks, with swimming goggles.
• Eye make-up: after two weeks, with new products.
• Outdoor work in dusty conditions: with protective glasses, following your doctor’s instructions.

These times are a guide. The ophthalmologist adjusts the instructions according to the technique used and how healing is progressing.

Pterygium in young people

When a pterygium appears at a young age, it tends to be more “active” and more likely to come back after removal. That is why, with younger patients, we place particular emphasis on prevention, with consistent use of sunglasses, and carefully plan the timing and technique of the procedure. Choosing a conjunctival autograft is especially important at this age.

Questions worth asking your ophthalmologist

• How far has the pterygium advanced onto the cornea?
• Is it causing astigmatism, and how much?
• Does it need removing now, or can we wait?
• Which technique will be used to reduce the chance of recurrence?
• How often should I have a check-up?

Why a pterygium becomes red and irritated

Many patients notice that their pterygium “flares up” on some days: it becomes redder, more swollen and stings. These flare-ups are usually triggered by exposure to sun, wind, dust or smoke, or by tiredness and lack of sleep. The raised surface of the pterygium also disrupts the tear film around it, so the area dries out more easily and becomes irritated. During these periods, preservative-free artificial tears, cold compresses and avoiding irritants all help. If flare-ups are frequent, the ophthalmologist may prescribe a short course of anti-inflammatory treatment.

Pterygium and appearance

Besides vision, a pterygium also affects how the eye looks. A red, fleshy triangle on the white of the eye can make you look tired or irritated, and quite a few patients ask for removal for cosmetic reasons. This is a perfectly legitimate reason. With modern techniques and a conjunctival graft, the eye usually looks very natural after healing, without a visible mark.

After removal: how to prevent recurrence

• follow the eye drop schedule exactly and do not stop early
• wear sunglasses every time you go out, even on cloudy days
• avoid dust and wind for the first few months
• do not rub the eye
• attend your scheduled follow-up visits, so that an early recurrence can be spotted and treated promptly

How to tell if a pterygium is growing

Because a pterygium develops slowly, changes are hard to notice in the mirror. Signs worth watching for include more redness, a feeling that the tissue is “getting closer” to the pupil, blurred vision that does not improve with glasses, and needing a new prescription more often. A practical tip is to take a photo of your eye in good light every few months and bring it to your follow-up. The final assessment, however, is always based on measurement at the slit lamp and corneal topography, which show its progress accurately.

Can it appear in both eyes?

Yes. Quite a few patients have a pterygium in both eyes, not because it spreads but because both eyes are exposed to the same factors. Usually one is more advanced than the other. Each eye is assessed separately and, if both need removal, the procedures are done at different times.

Pterygium and driving

A pterygium that has advanced onto the cornea can cause glare from car headlights and blurred vision, especially at night, because of the astigmatism it creates. If you have difficulty driving or see “streaks” around lights, tell your ophthalmologist, as this may be a reason to remove it sooner than would otherwise be recommended.

In every case, the final decision on whether and when to remove a pterygium is made together with your doctor, based on the examination and your own needs.

If you have questions about your pterygium or want to know whether it is the right time for removal, an examination at the clinic will give you a clear picture and a personalised plan.

Frequently Asked Questions about Pterygium

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO