eMedicine Specialties > Ophthalmology > Conjunctiva

Pterygium: Differential Diagnoses & Workup

Author: Jerome P Fisher, MD, FACS, Volunteer Assistant Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine
Coauthor(s): William B Trattler, MD, Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute
Contributor Information and Disclosures

Updated: Jan 12, 2009

Differential Diagnoses

Squamous Cell Carcinoma, Conjunctival

Other Problems to Be Considered

  • Pseudopterygia (eg, chemical or thermal burn, trauma, marginal corneal disease)
  • Neoplasia (eg, carcinoma in situ, squamous cell carcinoma, other neoplastic diseases)
  • Pingueculae (ie, actinic lesions confined to the perilimbal conjunctiva that do not extend onto the cornea)
    • Pingueculae are commonly occurring, generally small and asymptomatic (often yellow) raised nodules appearing on the bulbar surface of the conjunctiva. They are found more commonly on the nasal side, but they can also present either on the temporal conjunctiva or on both the nasal and temporal conjunctiva in the eyes of some patients.
    • Pingueculae are thought to be associated with actinic (sunlight) exposure in susceptible individuals.
    • Pingueculae can occasionally be subject to some inflammation with symptoms of itching, burning, or mild pain. In the absence of inflammation or of significant cosmetic complaints, pingueculae are generally ignored (by patient and physician alike). If mildly symptomatic, like pterygia, they can be treated with artificial tears.
    • On rare occasions, ocular anti-inflammatory drops may be required. On even more infrequent occasions, surgical excision may be of benefit in the management of pingueculae.
    • Histopathologically, pingueculae show mild-to-moderate focal thickening of the conjunctival stroma with elastotic degeneration of collagen.

Workup

Imaging Studies

  • Corneal topography can be very useful in determining the degree of irregular astigmatism induced by advanced pterygia.
  • External photography can assist the ophthalmologist in following the progression of the pterygium.

Procedures

  • Multiple different procedures have been advocated in the treatment of pterygia. These procedures range from simple excision to sliding flaps of conjunctiva with and without adjunctive external beta radiation therapy and/or use of topical chemotherapeutic agents, such as mitomycin C.
  • Using free grafts of conjunctiva (with or without limbal tissue) at the same time as primary excision of the lesion has been widely advocated as the preferred treatment modality for aggressive pterygia. For moderate-to-severe pterygia, some corneal surgeons use amniotic membrane transplants. Both the conjunctival autografts and the amniotic membrane transplants may be sutured onto adjacent conjunctiva and subjacent cornea. Some corneal surgeons seal the graft tissue onto the underlying sclera with the aid of fibrin tissue glue rather than with sutures.

More on Pterygium

Overview: Pterygium
Differential Diagnoses & Workup: Pterygium
Treatment & Medication: Pterygium
Follow-up: Pterygium
References
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References

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Further Reading

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Keywords

pterygia, ocular mass, ocular lesion, corneal surface, corneal topography, diplopia, double vision, vision loss

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Contributor Information and Disclosures

Author

Jerome P Fisher, MD, FACS, Volunteer Assistant Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine
Jerome P Fisher, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, and Florida Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

William B Trattler, MD, Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute
William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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