Pterygium and pinguecula – Disease and surgery
Pinguecula and pterygium are growths of the conjunctiva (the whitish membrane surrounding the iris) on the cornea (the clear, transparent surface in front of the iris). A pinguecula is a yellowish growth made up of a deposit of protein, fat, or calcium. A pterygium is a growth of fleshy tissue (containing blood vessels) that can start as a pinguecula. These growths may remain small or grow large enough to cover part of the cornea. When this happens, it can affect your vision. Pterygium and pinguecula are most commonly found on the side of the nose. Although the exact cause is unknown, both are thought to be caused by a combination of exposure to ultraviolet (UV) rays from the sun, wind, and dust.
Symptoms
Although often asymptomatic, pterygium and pinguecula can become inflamed and cause irritation of the ocular surface. In such cases, the patient presents with the typical triad of symptoms: pain, redness, and photophobia (sensitivity to light).
Outside of flare-up phases, you may experience the following symptoms:
A yellowish spot or bump on the white of the eye.
A slight visual blur.
Dry, itchy, burning eyes.
A sensation of a foreign body.
Most often, patients consult a doctor concerned after noticing a growth that has gradually appeared on the inner corner of their eye. If there is no discomfort other than cosmetic concerns, it is advisable to refrain from treatment.
When the lesion progresses, vision may be affected by the induction of astigmatism or the obscuration of the visual axis: treatment is necessary.
Diagnosis
The diagnosis is established by examination with a slit lamp (tabletop microscope). The ophthalmologist confirms the presence of a limbal growth (at the border between the conjunctiva and the cornea), triangular in shape, on the side of the nose.
The diagnosis is usually clear clinically, but histopathological confirmation (analysis after biopsy) is frequently performed in cases of surgery. Indeed, in exceptional cases, dysplasia (a precancerous lesion) or even neoplasia (cancerous involvement) may be diagnosed.
Causes and risk factors
The formation of pterygia is strongly correlated with UV exposure.
The disease mainly affects patients living in sunny regions (Southern France) or practicing outdoor activities (surfer's eye).
Prevention – Avoiding pinguecula and pterygium
If you have the beginning of a pinguecula or pterygium, it is best to follow these tips:
Sun protection – Wear category 3 or 4 sunglasses to protect your eyes from ultraviolet (UV) rays.
External protection – Protect your eyes from dust by wearing prescription glasses or safety glasses.
Hydrate your eyes – Use artificial tears when your eyes are dry.
Calm the inflammation – In case of intense redness or pain, consult an ophthalmologist so that they can prescribe a short course of anti-inflammatories.
Medical treatment
In the absence of a severe inflammatory flare-up, pterygium and pinguecula do not require treatment. The prescribed eye drops are intended for ocular comfort.
Moisturizing eye drops (artificial tears) – Lubricating your eyes helps relieve the irritation caused by the pinguecula. Eye drops also help relieve the foreign body sensation.
Anti-inflammatory eye drops – If you experience redness, pain, or swelling of the eye, your doctor may prescribe steroidal (corticosteroid) or non-steroidal (ibuprofen) anti-inflammatory eye drops. These will soothe the redness and discomfort. However, they should only be used as needed and appropriately as necessary.
Surgery is almost never necessary in cases of pinguecula.
Pterygium surgery
Pterygium surgery involves removing a benign growth of the conjunctiva on the cornea. The conjunctiva is the thin, whitish membrane that covers the white part of the eye and the inside of the eyelids.
Most often, a pterygium produces few or no visual symptoms. If the growth covers the cornea, approaches the visual axis, or causes astigmatism, then it must be surgically removed.
The procedure takes place in the operating room, under local anesthesia. The membrane is removed and a graft taken from another area of the conjunctiva is glued or sutured to cover the hole left.
Before the operation
Pterygium surgery is a common and minimally invasive procedure.
It usually takes no more than 30 minutes.
A pre-operative anesthesia consultation is, however, advisable.
A 6-hour fast allows for good anesthetic conditions.
You will be lightly sedated; a product will be administered to help you relax.
The return home will be accompanied by a relative or a taxi; you will not be able to drive.
What to expect during pterygium surgery?
Pterygium surgery is fairly quick and low-risk:
Local anesthesia using drops allows the eye to be disinfected and the operation to begin painlessly.
In case of anxiety or tremors, the anesthesiologist will increase the sedation, you will be in a semi-conscious state.
You will be covered with a sterile drape and will not see the instruments, nor what the surgeon is doing.
He uses a microscope to be very precise.
Your surgeon will remove the pterygium along with some of the surrounding diseased connective tissue. This is done using microscopic instruments. The procedure is performed manually and does not involve a laser.
Once the pterygium is removed, your doctor replaces it with a graft of healthy connective tissue, taken from an unaffected area of your eye.
This technique helps to reduce the risk of pterygium recurrence.
Sutures or glue
Once the pterygium is removed, the surgeon will use either absorbable sutures or fibrin glue to fix the connective tissue graft sealing the area of the removed pterygium.
Suturing with absorbable thread is considered the historical gold standard. However, it results in greater discomfort after the operation and prolongs recovery time.
Biological glue reduces postoperative inflammation and discomfort, while also halving recovery time (compared to sutures). However, using glue is significantly more expensive than using sutures, making its cost-effectiveness limited.
Convalescence and recovery
At the end of the operation, your doctor will apply an antibiotic ointment to prevent infection and a protective dressing for your comfort.
It is important not to rub your eyes after the procedure to avoid "pulling out" the stitches.
Treatments include saline wash, antibiotic + anti-inflammatory eye drops and moisturizing drops or gel for comfort.
Recovery time is approximately 15 days. However, redness may persist for 1 to 3 months in some patients.
Complications
As with any surgical procedure, there are risks. After pterygium surgery, it is normal to experience some discomfort and redness. Blurred vision is also common during recovery.
Complications, however, are rare:
Recurrence – This is the most frequent but also the least serious complication. A few years (sometimes a few months) after the operation, the pterygium grows back, causing a recurrence of the problem.
Deepening ulcer – Despite the graft, healing occurs abnormally and the ocular wall thins. A new autograft or the placement of a healing membrane may be necessary.
Perforation – During surgery for a deep pterygium, or a few days later for a deep ulcer, the corneal or scleral wall may rupture, resulting in a perforation of the eyeball. This is an extremely rare but serious complication.
In case of sudden vision loss or postoperative pain that causes insomnia and is resistant to pain medication, consult your surgeon immediately.
Prognosis
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Pterygium surgery is a highly controlled procedure. After the operation, the astigmatism caused by the abnormal skin will gradually regress.
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Glasses can be prescribed 4 to 6 weeks after the operation.
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It will be necessary to continue to avoid the risk factors for pterygium: sun protection and eye hydration.
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In case of recurrence, a new operation may be performed.