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Pterygium Questions

Serving Orange County, Beverly Hills and Surrounding Los Angeles Communities

What is Pterygium?
A pterygium is a growth of the clear, thin tissue that lays over the white part of the eye (conjunctiva) closest to the nasal and grows over the cornea. The name derives from a Greek word meaning butterfly shaped. One or both eyes may be involved. Pterygium can vary in size from small to large. Once a pterygium has grown onto the cornea it can cause vision disabilities. It is possible for a pterygium to grow over the pupillary zone and cause vision loss. Some pterygia may become red and swollen on occasion. They may become fleshy and red. Large and advanced pterygia can actually cause a distortion of the surface of the cornea (Corneal Scarring) and induce astigmatism. That means that the pressure of the pterygium causes the normal basketball shape of cornea to be changed to football shape.

What are the Causes?
The exact cause is unknown, but it is associated with excessive exposure to wind, sunlight, or sand. UV radiation is the most likely culprit. Therefore, it is more likely to occur in populations that inhabit the areas near the equator, Pterygium is rare in children. Additionally, Pterygium is twice more likely to occur in men than women. In the Hispanic population there is a high incidence of this disease. Also early onset and recurrences are more common.

What are the Symptoms?
Many people with pterygia do not experience symptoms. The primary symptoms of a pterygium are painless area of elevated white tissue, with blood vessels on the inner or outer edge of the cornea (inflammation), persistent redness, foreign body sensation, and dry, itchy eyes. This may cause concern about appearance or create a feeling of having a foreign body in the eye.

How can it be Prevented?
As it is associated with excessive sun or wind exposure, wearing protective sunglasses with side shields and/or wide brimmed hats and using artificial tears throughout the day may help prevent their formation or stop further growth. Surfers and other water-sport athletes should wear eye protection that block 100% of the UV rays from the water, as is often used by snow-sport athletes. Other diseases that may cause surface inflammation such as dry eye, allergy/atopy or demodex blepharitis should be eliminated or controlled.

The aggressiveness of a pterygium can be judged by looking at the lesion's morphology through a slit lamp. In a more aggressive pterygium the episcleral vessels are obscured by dense fibrovascular growth.

How Can it be Treated?
Definitive treatment is achieved only by surgical removal. The pterygia may be removed in a procedure room at the doctor's office or in an operating room setting. It is up to your eye doctor to determine the best procedure for you. The treatment requires some local anesthetic in the eye and is best done at the time of the pterygium excision to deaden feeling in your eye's surface. Conjunctival auto-grafting is a surgical technique that is effective and safe procedure for pterygium removal. When the pterygium is removed the tissue that covers the sclera known as the conjunctiva is also extracted, auto-grafting replaces the bare sclera with tissue that is surgically removed from the inside of the patients’ upper eyelid. That “self-tissue” is then transplanted to the bare sclera and is fixated using sutures, tissue adhesive, or glue adhesive. After treatment you should be able to return to work.

Suture-less Painless Pterygium Surgery
At the Khanna institute of vision we offer the latest suture-less technique of pterygium surgery. Drops or gel are used to numb the eye. The pterygium is then removed. A graft, which is a thin clear membrane like cellophane paper is then glued on. Most patients can go back to work or normal activities the next day.

Adjunctive methods

1) Treatment of dry eyes with artificial tears and punctal occluders
2) Treatment of demodex blepharitis
3) Wearing polarized sunglasses
4) Restasis eye drops

Is There a Possibility of Reoccurrence?
In fact, the recurrence rate is between 3 percent and 40 percent. To prevent re-growth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called auto-grafting, is very safe and has a low recurrence rate. Even though the use of auto-grafts has resulted in better success rates, it is technically difficult, time consuming. You will be happy to know that Dr. Khanna has performed thousands of such surgeries. Simple excision without auto-grafting carries a high recurrence rate ranging from 24% to 89%. The addition of mitomycin C (MMC) has been reported to be effective in preventing recurrence. However, postoperative application MMC, especially on a bare sclera, may result in devastating complications such as scleral necrosis and infections.

What are the Complications?

1. Blindness: if the pterygium crosses the dark part of your eye it can interfere with the light reaching the eye. This can lead to blindness.
2. Restriction of eye movement: pterygium can be considered like an elastic string attached to the eye. If this becomes fibrotic the elasticity is lost the pterygium then acts like a restrictive chain interfering with eye movements.
3. Decreased Vision and astigmatism: As the pterygium grows it pushes the corneal tissue causing flattening in the horizontal axis. This causes vision problems.
4. Cancer: Pterygium may harbor cancer cells some times. This is more common if it is a younger patient, only one eye has a pterygium (asymmetric), or the pterygium starts growing aggressively. It is recommended to do a biopsy examination on these removed specimens.

Does Insurance Cover this Surgery?
Good news! Yes if you have medical insurance they will cover the cost of the surgery. Medicare, blue cross, BlueShield etc, will cover medically indicated Pterygium surgery. Vision Insurances like VSP or MES do not cover such surgeries. We do accept cash or credit cards if you do not have insurance.

Can You Have LASIK ?
Dr. Khanna recommends to first taking care of Pterygium. Removal of the pterygium releases the tension on the cornea and allows it to return back to its normal shape. If LASIK is done first than there is a chance that the pterygium might grow over the flap causing problems, including dissolution of the flap. Also surgical removal becomes difficult, and when the pterygium is removed the number may recur. Then either LASIK, SuperLASIK or presbyopic implants may be implanted.

When to Contact a Medical Professional
A person with pterygium should be seen by an ophthalmologist annually, so that the advancement of the pterygium can be recognized, especially before the pupillary zone becomes involved.

Call for an appointment with your ophthalmologist if you have had a pterygium in the past and symptoms recur.