What are pterygia?
A large inflamed pterygium that is beginning to obstruct the pupil.
Pterygia are triangular shaped growths that start on the sclera, or ‘white’ of the eye, and slowly grow out onto the cornea.
Pterygia are a type of scar tissue. The majority are caused by ultraviolet light.
Complications of pterygia
All pterygia cause problems to some extent.
An individual may suffer from one or many of the following symptoms:
- An unacceptable appearance. Some pterygia become very large and unsightly
- Intermittant or constant inflammation resulting in redness and discomfort
- Visual distortion due to corneal warpage or scarring
- Obstruction of the pupil
Mimics of pterygia
Several diseases of the conjunctiva can mimic pterygia. The most common mimic is ocular surface squamous neoplasia.
How is it diagnosed?
Most pterygia are first noticed by patients and their friends.
In many cases the diagnosis is confirmed by an optometrist.
Troublesome or atypical pterygia are reviewed by eye specialists who examine the abnormal tissue with the slit lamp microscope.
Most pterygia can be treated without the need for surgery.
There are a number of things patients can do to minimise symptoms and lessen the likelihood of the pterygium growing.
Key strategies include:
- Reduce ultraviolet light exposure. Wear a broad brimmed hat and sunglasses
- Avoid irritants and drying – smoky, dusty and air-conditioned environments
- Use artificial tears to moisturise the eye
In some patients more active medical treatments are required. These include:
- Whitening or decongestant agents
- Steroid or non-steroid anti-inflammatory drops
Decongestant eye drops
Decongestants can be used to whiten very red pterygia
Some patients with very reddened pterygia benefit from drops that constrict the blood vessels. Long-held fears that the use of such drugs may lead to dependancy or enlargement of the blood vessels are unfounded.
Anti-inflammatory eye drops
Patients with significantly inflamed pterygia are treated with anti-inflammatory drugs, the most sucessful of which are topical steroids. Treatment with steroids must be supervised by an ophthalmologist.
In some patients pterygia must be removed surgically.
Reasons to remove pterygia
The most common reasons pterygia are removed are:
- Unacceptable appearance
- Symptoms not controlled by medical treatments
- Corneal distortion, scarring or growth over the pupil
- Concern the growth may not be simply a pterygium but a tumour of the conjunctiva
Pterygium surgery requires careful planning and meticulous surgery. Research has shown that the best way to deal with pterygia is to:
- Remove the abnormal tissue
- Cover the bare underlying sclera with a small piece of conjunctival tissue taken from under the upper eyelid. This tissue is known as an autologous conjunctival graft.
- Treat the eye with topical steroids for a prolonged period after the surgery
- Consider the use of additional treatment such as Mitomycin C, a drug that reduces scarring and lessens the likelihood of pterygium recurrence
Removal of the pterygium
Removing pterygia is a very straightforward process. Only local anaesthesia and light sedation are required. For more information see having pterygium surgery
Autologous conjuctival grafting
If pterygia are simply removed and the area left to scar, recurrence will occur in approximately one third of all patients. Covering the area with a piece of conjuctival tissue reduces the recurrence rate down to approximately 1%.
Free conjunctival grafts are taken from the surface of the eye covered by the upper eyelid and are sutured or glued into place; a time consuming process. The harvest bed regenerates.
Post operative care
It is very important to minimise post operative inflammation following pterygium surgery. It is common to use steroid eye drops for up to three months.
Mitomycin is an anti-scarring drug that is sometimes used to minimise the risk of pterygium recurrence. Mitomycin drops are used for several weeks, beginning a week after surgery.
Having pterygium surgery
The following instructions are intended to guide patients through the process of pterygium surgery under Dr McKellar’s care at the Day Stay unit at Christchurch Eye Surgery.
For more detail on the technical aspects of surgery please see surgical treatment of pterygium.
Prior to surgery
You will have received several documents including a prescription for eye drops and pain relief tablets.
Before your pre-admission visit please:
- Complete the Christchurch Eye Surgery admission form
- Read the brochure entitled ‘Pterygium Surgery’ produced by The Royal Australian and New Zealand College of Ophthalmologists
- Note down any questions you want to ask Dr McKellar
- Collect your eyedrops and pain relief tablets from a pharmacy
You will see Dr McKellar prior to your operation for a pre-admission assessment, usually on the morning of surgery. At this visit:
- Dr McKellar will finalise his surgical planning
- There will be a time to ask and have answered any questions
- Legal documents including the ‘Consent to Operate’ are completed
- Your appointment times will be confirmed
On the day of surgery
The following instructions are specific to Dr McKellar’s patients and afternoon surgery. Please DISREGARD any other information you have read or been told by any other person.
- Wear comfortable clothing; an open neck top is preferable but not essential. You will NOT need to change out of your clothes.
- You may EAT NORMALLY. You do NOT need to fast and can DISREGARD the instructions on the Christchurch Eye Surgery form which are intended for patients having surgery under general anaesthesia.
- Continue with all your usual medicines. You DO NOT need to stop aspirin or warfarin.
At Christchurch Eye Surgery
Please arrive at Christchurch Eye Surgery no later than the time you have been given. Expect to be at the hospital for 2-2½ hours. During your time at the hospital:
- A nurse will give you pain relief tablets PRIOR to surgery to minimise postoperative pain
- You will be placed on an ‘eye bed’
- Dr McKellar’s anaesthetist will give light sedation if required
- Your eye will be anaesthetised
- Dr McKellar will clean around your eye, cover the eye with a sterile drape and perform the surgery required.
- During surgery you will be aware of light from the operating microscope, Dr McKellar’s hands touching around your eye, and machine noises. You may feel mild pressure in your eye but not pain.
- For more detailed information on the technical aspects of eye surgery see Pterygium-Surgical treatment.
- At the end of surgery a tight, ‘double-pad’ dressing will be applied over the eye
After pterygium surgery
You may bend down and resume normal physical activities.
Take the pain relief tablets as directed.
Removing your dressing
Leave the ‘double-pad’ dressing in place until the morning after surgery.
It is normal for the pad to be blood-stained and coated in mucous.
Clean around your eyelids with cooled boiled water and and a soft flannel.
Following routine pterygium surgery your eye will be checked on several occasions. The first visit is usually the day after surgery. Subsequent visits will be arranged as needed. At least 5 visits over three months will be required.
What is normal?
Following pterygium surgery:
- Expect to feel miserable for a few days.
- Although you will be having day surgery under local anaesthesia the surface of the eye is very sensitive and takes several days to heal.
- There may be moderate pain in the first 24 hours. You will need to take regular pain relief such as paracetamol.
- There will be some swelling in the area where the pterygium was removed and the conjunctival graft placed.
- It may take several days for the focus of your eye to settle and there may be some fluctuation in your vision for several weeks.
- Your eye will be more sensitive to light after surgery, so you may want to wear sunglasses for your own comfort during this time.
- A watery eye and nose are common.
- Redness will be present for up to 3 months.
What is NOT normal?
Please let Dr McKellar know if any of the following occur:
- Severe or progressively worsening pain
- Decreased vision
Eye drops are critical to the success of pterygium surgery. They reduce the chance of pain, infection and ultimately, recurrence of the pterygium. You will normally have two types of eye drops. Please let Dr McKellar know if you have ever had an allergic reaction to any of the medication in the eyedrops prescribed.
|Chloramphenicol||4 times a day||After eye-pad removed||1 week after surgery|
|Maxidex||4 times a day||After eye-pad removed||3 months after surgery|
Pterygium surgery involves the removal of tissue from the most sensitive part of the body. Without pain relief pterygium surgery can be very painful.
Dr McKellar has prescribed three different pain medications. You should use all three for the first few days.
It is wise to take your pain tablets ‘by the clock’ to avoid pain occurring. Preventing pain is easier than treating pain.
|Paracetamol||1000mg||Every 4 hours, maximum 8 tablets every 24 hours|
|Codeine||60mg||Every 4 hours, maximum 8 tablets every 24 hours|
|Tramadol||50mg||Every 4 hours, maximum 8 tablets every 24 hours|
If you have any pain or blurring THAT INCREASES over a day, at any stage after your surgery, contact Dr McKellar immediately. The rooms’ telephone number is (03) 366-1682. Outside of working hours call (03) 348-4155 or 021 -724-222.
If at any stage you cannot contact Dr McKellar urgently, ring Christchurch Public Hospital and ask for ‘The eye doctor on call’.
FAQs and Links
Are pterygia cancers?
No, although in rare cases surface tumours of the eye may look very similar.
Can pterygia permanantly damage my vision?
Only if they are allowed to grow across the pupil.
Can pterygia re-grow after surgery?
Yes. Even after meticulous surgery, approximately 5% of pterygia will recur.
Is pterygium surgery painful?
Not usually. Surgery is performed under local anaesthesia. Post operatively patients are given a variety of oral pain medications such as panadol, codeine and diclofenac.