eMedicine Specialties > Ophthalmology > Conjunctiva

Pterygium

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

Introduction

Background

A pterygium is an elevated, superficial, external ocular mass that usually forms over the perilimbal conjunctiva and extends onto the corneal surface. Pterygia can vary from small, atrophic quiescent lesions to large, aggressive, rapidly growing fibrovascular lesions that can distort the corneal topography, and, in advanced cases, they can obscure the optical center of the cornea.

Pathophysiology

The pathophysiology of pterygia is characterized by elastotic degeneration of collagen and fibrovascular proliferation, with an overlying covering of epithelium. Histopathology of the abnormal collagen in the area of elastotic degeneration shows basophilia with hematoxylin and eosin stain. This tissue also stains with elastic tissue stains, but it is not true elastic tissue, in that it is not digested by elastase.

Frequency

United States

Occurrence within the United States varies with geographical location. Within the continental United States, prevalence rates vary from less than 2% above the 40th parallel to 5-15% in latitudes between 28-36°. A relationship is thought to exist between increased prevalence and elevated levels of ultraviolet light exposure in the lower latitudes.

International

Internationally, the relationship between decreased incidence in the upper latitudes and relatively increased incidence in lower latitudes persists.

Mortality/Morbidity

Pterygia can cause a significant alteration in visual function in advanced cases. They also can become inflamed, resulting in redness and ocular irritation.

Sex

Pterygia are reported to occur in males twice as frequently as in females.

Age

It is uncommon for patients to present with pterygia prior to age 20 years. Patients older than 40 years have the highest prevalence of pterygia, while patients aged 20-40 years are reported to have the highest incidence of pterygia.

Clinical

History

Patients with pterygia present with a variety of complaints, ranging from no symptoms to significant redness, swelling, itching, irritation, and blurring of vision associated with elevated lesions of the conjunctiva and contiguous cornea in one or both eyes.

Physical

A pterygium can present as any of a range of fibrovascular changes on the surface of the conjunctiva and the cornea. It is more common for the pterygium to present on the nasal conjunctiva and to extend onto the nasal cornea, although it can present temporally, as well as in other locations.

  • The clinical presentation can be divided into 2 general categories, as follows:
    • One group of patients with pterygium can present with minimal proliferation and a relatively atrophic appearance. The pterygia in this group tend to be flatter and slow growing and have a relatively lower incidence of recurrence following excision.
    • The second group presents with a history of rapid growth and a significant elevated fibrovascular component. The pterygia in this group have a more aggressive clinical course and a higher rate of recurrence following excision.

Causes

  • Risk factors for pterygium include the following:
    • Increased exposure to ultraviolet light, including living in subtropical and tropical climates
    • Engaging in occupations that require outdoor activities
  • A genetic predisposition to the development of pterygia appears to exist in certain families.
  • A predilection exists for males to develop this condition in significantly higher numbers than females, although this finding may represent an increased exposure to ultraviolet light in this portion of the population.

More on Pterygium

Overview: Pterygium
Differential Diagnoses & Workup: Pterygium
Treatment & Medication: Pterygium
Follow-up: Pterygium
References
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.