AKT · Ophthalmology/Lids & surface

Pterygium

Fibrovascular conjunctival overgrowth onto the cornea (UV/chronic surface exposure)

Overview

A wing-shaped fibrovascular growth of conjunctiva extending onto the nasal cornea, driven by chronic UV/wind/dust exposure ('surfer's/farmer's eye'). Usually cosmetic/irritative; surgery if it threatens the visual axis or causes astigmatism.

Recognise

Triangular fleshy conjunctival growth crossing the limbus onto the cornea, usually nasal
Irritation, redness, foreign-body sensation; astigmatism or visual-axis encroachment if advanced
Sunny/outdoor exposure history

Red flags

Atypical, rapidly growing or pigmented lesion → consider ocular surface squamous neoplasia/melanoma (refer)

Differentials & how to tell them apart

Pingueculayellowish conjunctival nodule that does NOT cross onto the cornea

Conjunctival intraepithelial neoplasiaatypical gelatinous/leukoplakic lesion — biopsy

Pannusvascular ingrowth from chronic inflammation (e.g. trachoma, contact lens)

Pterygium — fibrovascular growth extending onto the cornea
Jmvaras José Miguel Varas, MD / CC BY 3.0 — Wikimedia Commons

Investigations

Clinical; document encroachment onto the cornea and refraction if visual symptoms.

Management

Lubricants + UV protection; surgical excision if it threatens vision

1Lubricants for irritation; sunglasses/UV protection to slow growth.Gate: Refer for excision if it encroaches on the visual axis, induces significant astigmatism, or looks atypical (neoplasia)
2Surgical excision with conjunctival autograft (recurrence is common).

Lubricants ± short topical steroid for inflammation — symptomatic relief

UV protection (sunglasses) — slows progression

Key points

Crosses onto the cornea = pterygium; stops at the limbus = pinguecula. UV exposure is the link.

Monitor & prognosis

Growth toward the visual axis.

Benign; can recur after surgery.

Source: College of Optometrists CMG