eMedicine Specialties > Ophthalmology > Conjunctiva

Pterygium: Follow-up

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

Follow-up

Further Outpatient Care

  • Postoperatively, after pterygium excision, the topical steroids are slowly tapered. Patients on topical steroids need to be observed to avoid problems, such as elevated intraocular pressure and cataracts.

Inpatient & Outpatient Medications

Deterrence/Prevention

  • Theoretically, minimizing exposure to ultraviolet radiation should reduce the risk of development of pterygia in susceptible individuals. Patients are advised to use a hat or a cap with a brim, in addition to ultraviolet-blocking coatings on the lenses of glasses/sunglasses to be used in areas of sun exposure. This precaution is even more important for those patients living in tropical or subtropical areas or for those patients who are engaged in outdoor activities with a high risk of ultraviolet exposure (eg, fishing, skiing, gardening, outdoor construction work).

Complications

  • Complications of pterygia include the following: 
    • Distortion and/or reduction of central vision
    • Redness
    • Irritation
    • Chronic scarring of the conjunctiva and the cornea
    • Extensive involvement of the extraocular muscles may restrict ocular motility and contribute to diplopia.
      • In patients who have not yet undergone surgical excision, scarring of the medial rectus muscle is the most common cause of diplopia.
      • In patients with pterygia who have previously undergone surgical excision, scarring or disinsertion of the medial rectus muscle is the most common cause of diplopia.
  • In patients with significantly elevated pterygia, focal drying and subsequent thinning of the adjacent cornea may rarely occur.
  • Postoperative complications of pterygium repair can include the following:
    • Infection
    • Reaction to suture material
    • Diplopia
    • Conjunctival graft dehiscence
    • Corneal scarring
    • Rare complications may include perforation of the globe, vitreous hemorrhage, or retinal detachment.
  • Late postoperative complications of beta radiation of pterygia can include the following:
    • Scleral and/or corneal thinning or ectasia can present years or even decades after treatment.
    • Some of these cases can be quite difficult to manage.
  • In some cases, adjunctive use of topical mitomycin-C at and after pterygium surgery has been reported to cause similar ectasia or melting of the sclera and/or the cornea.
  • The most common complication of pterygium surgery is postoperative recurrence. Simple surgical excision has a high recurrence rate of approximately 50-80%. The rate of recurrence has been reduced to approximately 5-15% with use of conjunctival/limbal autografts or amniotic membrane transplants at the time of excision.
  • On rare occasion, malignant degeneration of epithelial tissue overlying an existing pterygium can occur.

Prognosis

  • The visual and cosmetic prognosis following excision of pterygia is good. The procedures are well tolerated by patients, and, aside from some discomfort in the first few postoperative days, most patients are able to resume full activity within 48 hours of their surgery. Those patients who develop recurrent pterygia can be retreated with repeat surgical excision and grafting, with conjunctival/limbal autografts or amniotic membrane transplants in selected patients.

Patient Education

  • Patients who are at high risk of the development of pterygia because of a positive family history of pterygia or because of extended exposure to ultraviolet irradiation need to be educated in the use of ultraviolet-blocking glasses and other means of reducing ocular exposure to ultraviolet light.

Miscellaneous

Medicolegal Pitfalls

  • As in any surgical procedure, careful informed consent must be obtained from the patient prior to surgery. While this procedure is fairly common with a very good visual prognosis in most patients, any ocular procedure can be associated with infection, perforation of the globe, vitreous hemorrhage, endophthalmitis, retinal detachment, or diplopia.
  • Patients should be informed that redness and irritation may persist for longer than a month postoperatively.
  • Patients should be informed about the chance of recurrence.
  • The surgeon should check all biopsy results after excision of pterygium to rule out the possibility of an atypical presentation of a malignancy masquerading as a benign pterygium.
 


More on Pterygium

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

  1. Anduze AL. Pterygium surgery with mitomycin-C: ten-year results. Ophthalmic Surg Lasers. Jul-Aug 2001;32(4):341-5. [Medline].

  2. Bahar I, Weinberger D, Gaton DD, Avisar R. Fibrin glue versus vicryl sutures for primary conjunctival closure in pterygium surgery: long-term results. Curr Eye Res. May 2007;32(5):399-405. [Medline].

  3. Blum HF. Carcinogenesis by Ultraviolet Light. Princeton University Press; 1959.

  4. Cogan DG, Kuwabara T, Howard J. The nonelastic nature of pingueculas. Arch Ophthalmol. 1959;61:388.

  5. Cohen RA, McDonald MB. Fixation of conjunctival autografts with an organic tissue adhesive. Arch Ophthalmol. Sep 1993;111(9):1167-8. [Medline].

  6. Coroneo MT, Di Girolamo N, Wakefield D. The pathogenesis of pterygia. Curr Opin Ophthalmol. Aug 1999;10(4):282-8. [Medline].

  7. Elliot R. The aetiology of pterygium. Trans Ophthalmol Soc NZ. 1961;13:22.

  8. Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, et al. Outcome of pterygium surgery: analysis over 14 years. Eye. Nov 2005;19(11):1182-90. [Medline].

  9. Fuchs E. Uber das Pterygium. Albert von Graefes Arch Klin Exp Ophthalmol. 1892;38:1.

  10. Jain AK, Bansal R, Sukhija J. Human amniotic membrane transplantation with fibrin glue in management of primary pterygia: a new tuck-in technique. Cornea. Jan 2008;27(1):94-9. [Medline].

  11. Kamel S. The Pterygium: its etiology and treatment. Am J Ophthalmol. 1954;38:682.

  12. Kheirkhah A, Casas V, Sheha H, Raju VK, Tseng SC. Role of conjunctival inflammation in surgical outcome after amniotic membrane transplantation with or without fibrin glue for pterygium. Cornea. Jan 2008;27(1):56-63. [Medline].

  13. Lee JS, Oum BS, Lee SH. Mitomycin c influence on inhibition of cellular proliferation and subsequent synthesis of type I collagen and laminin in primary and recurrent pterygia. Ophthalmic Res. May-Jun 2001;33(3):140-6. [Medline].

  14. McDonald JE, Wilson FM. Ocular therapy with beta particles. Trans Am Acad Ophthalmol Otolaryngol. 1959;63:468.

  15. Miyai T, Hara R, Nejima R, Miyata K, Yonemura T, Amano S. Limbal allograft, amniotic membrane transplantation, and intraoperative mitomycin C for recurrent pterygium. Ophthalmology. Jul 2005;112(7):1263-7. [Medline].

  16. Oguz H. Amniotic membrane grafting versus conjunctival autografting in pterygium surgery. Clin Experiment Ophthalmol. Aug 2005;33(4):447-8. [Medline].

  17. Raiskup F, Solomon A, Landau D, Ilsar M, Frucht-Pery J. Mitomycin C for pterygium: long term evaluation. Br J Ophthalmol. Nov 2004;88(11):1425-8. [Medline].

  18. Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S, et al. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology. Nov 1992;99(11):1647-54. [Medline].

  19. Saw SM, Tan D. Pterygium: prevalence, demography and risk factors. Ophthalmic Epidemiol. Sep 1999;6(3):219-28. [Medline].

  20. Singh G, Wilson MR, Foster CS. Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea. Oct 1990;9(4):331-4. [Medline].

  21. Srinivasan S, Slomovic AR. Eye rubbing causing conjunctival graft dehiscence following pterygium surgery with fibrin glue. Eye. Jun 2007;21(6):865-7. [Medline].

  22. Starck T, Kenyon KR, Serrano F. Conjunctival autograft for primary and recurrent pterygia: surgical technique and problem management. Cornea. May 1991;10(3):196-202. [Medline].

  23. Tan D. Conjunctival grafting for ocular surface disease. Curr Opin Ophthalmol. Aug 1999;10(4):277-81. [Medline].

  24. Threlfall TJ, English DR. Sun exposure and pterygium of the eye: a dose-response curve. Am J Ophthalmol. Sep 1999;128(3):280-7. [Medline].

  25. Ti SE, Chee SP, Dear KB, Tan DT. Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol. Apr 2000;84(4):385-9. [Medline].

  26. Uy HS, Reyes JM, Flores JD, Lim-Bon-Siong R. Comparison of fibrin glue and sutures for attaching conjunctival autografts after pterygium excision. Ophthalmology. Apr 2005;112(4):667-71. [Medline].

  27. Yao YF, Qiu WY, Zhang YM, Tseng SC. Mitomycin C, amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with symblepharon and motility restriction. Graefes Arch Clin Exp Ophthalmol. Feb 2006;244(2):232-6. [Medline].

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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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