Pterygium and pterygium surgery explained
A pterygium (pronounced te-RIJ-ee-um) is a wedge-shaped, fleshy growth of the conjunctiva, the thin clear skin over the white of the eye, that extends onto the cornea, the clear window at the front. It usually starts on the side nearest the nose. It is not a cancer and it is not a cataract.
In brief
- Many pterygia need no surgery, only lubricating drops and sun protection.
- Surgery is considered when the growth affects vision or comfort, or is extending towards the centre of the cornea.
- At Dr. P. Siva Reddy Eye Hospital the growth is removed and the area is covered with a conjunctival autograft, a small piece of your own conjunctiva.
- It is usually a same-day procedure under local anaesthesia.
- The eye is sore and red at first. Redness fades over several weeks.
- A pterygium can come back after surgery. This is the main limit of the operation.
What causes it
The exact cause is not fully understood. Long-term exposure to ultraviolet light from the sun is the factor most consistently linked to it. Dust, wind and a dry eye surface are also thought to contribute. It is more common in people who spend years working outdoors and in sunny, dry climates.
Symptoms
- a visible pinkish or fleshy growth on the white of the eye
- redness that comes and goes
- a gritty, burning or itchy feeling, or a sense of something in the eye
- watering
- blurred vision, if the growth pulls on the cornea and changes its shape (astigmatism) or reaches the centre
When it can be left alone
A small pterygium that is not growing and not troublesome does not need to be removed. It is managed with:
- lubricating drops for dryness and irritation
- short courses of other drops for flare-ups of redness, when prescribed
- sunglasses that block ultraviolet light, and a cap or hat outdoors
- protection from dust and wind
- a check at intervals to see whether it is changing
When surgery is considered
- the growth is extending towards the centre of the cornea
- it is blurring vision or causing increasing astigmatism
- redness and irritation keep returning in spite of drops
- it restricts movement of the eye
- it interferes with contact lens wear
- its appearance concerns you
- its shape needs to be corrected before measurements for cataract surgery, in some eyes
The decision weighs how much the pterygium troubles you against the chance of it coming back. The doctor goes through both with you.
What happens in pterygium surgery
- Before the day: the eye is examined and measured, your general health and medicines are reviewed, and the procedure, its risks and the alternatives are explained. You are asked for written consent.
- Anaesthesia: the eye is numbed. You are awake, and you should not feel pain during the operation, though you may be aware of touch and of the bright light.
- Removal: the pterygium is lifted off the cornea and removed together with the tissue beneath it.
- Graft: a thin piece of healthy conjunctiva is taken from the same eye, usually from under the upper eyelid, and placed over the bare area. This is the conjunctival autograft. It is secured in place, and the surgeon will tell you the method used for your eye.
- Dressing: the eye is padded.
- Going home: it is usually a same-day procedure. You need someone to take you home.
The graft is used because leaving the area bare is associated with a higher rate of recurrence.
Recovery
| When | What to expect |
|---|---|
| First day | The eye is padded. Soreness and watering start as the anaesthetic wears off. A first check is usually arranged for the next day. |
| First one to two weeks | A gritty or scratchy feeling, watering, sensitivity to light and marked redness. This is expected and eases gradually. |
| Following weeks | Redness fades gradually. Drops are continued, with the dose reducing in steps as prescribed. |
| Later | Review visits check healing and look for any early sign of regrowth. |
- Use the drops exactly as charted and complete the course. Stopping early is thought to make recurrence more likely.
- Do not rub the eye.
- Keep water, dust and smoke away from the eye, and avoid swimming until you are cleared.
- Wear sunglasses outdoors during recovery, and keep doing so afterwards.
- Keep every follow-up visit.
General aftercare, including how to put in drops, is on the after your eye surgery page. Your own written instructions take priority.
Risks and limits
- Recurrence. The pterygium can grow back, most often within the first year. A graft lowers this chance and does not remove it. A recurrent pterygium can be more difficult to treat than the first.
- Redness and discomfort lasting some weeks. This is expected in every case.
- Infection. Uncommon. Increasing pain, discharge or worsening vision needs a call the same day.
- Problems with the graft, such as swelling, a small bleed under it, or the graft moving out of place. Some of these settle without treatment, and others need attention.
- A small lump of healing tissue or a cyst at the site, which may need treatment.
- A faint scar on the cornea where the pterygium was attached. If the growth had reached far onto the cornea, some blur or astigmatism can remain.
- A change in spectacle power, as the shape of the cornea settles after the growth is removed.
- Double vision or thinning of the white of the eye. Rare.
- The limits of the operation: the eye may not look completely white afterwards, and surgery does not treat the dryness or sun exposure that contributed to the growth. Lubricants and sun protection usually continue.
After surgery, call the same day if you have increasing pain, worsening vision, sticky discharge, or redness that is increasing instead of fading. During OPD hours, call 80966 65550. When the hospital is closed, go to the emergency department of a 24-hour hospital.
Looking after your eyes afterwards
- Sunglasses that block ultraviolet light, and a cap or hat, whenever you are outdoors.
- Protective glasses in dusty or windy conditions.
- Lubricating drops if your eyes are dry. See dry eye.
- An early visit if you notice redness or a growth returning.
Frequently asked questions
Is a pterygium cancer?
No. A pterygium is a non-cancerous growth of the thin skin covering the white of the eye. Rarely, other growths can look similar, which is one reason any growth on the eye should be examined, and why removed tissue may be sent to a laboratory.
Does every pterygium need surgery?
No. Many are small, stay the same for years and need only lubricating drops and protection from sunlight. Surgery is considered when the growth is affecting vision, is extending towards the centre of the cornea, causes irritation that drops do not control, or is a cosmetic concern to you.
Can drops remove a pterygium?
No. Drops can ease redness and irritation, but they do not make the growth smaller. Only surgery removes it.
Can a pterygium come back after surgery?
Yes. Recurrence is the main limit of pterygium surgery. Placing a conjunctival autograft over the area lowers the chance of recurrence compared with simply cutting the growth away, but no method removes the risk. Recurrence is more likely in younger people and with continued sun and dust exposure.
Is the surgery done under general anaesthesia?
In adults it is usually done with local anaesthesia, which numbs the eye while you stay awake. The surgeon will tell you what is planned for you.
How long is the recovery?
The eye is sore, watery and red at first. The discomfort usually eases over the first week or two, and the redness fades over several weeks. Drops are usually continued for several weeks.
When can I go back to work?
It depends on the work and on how the eye feels. Desk work is often possible within several days. Outdoor, dusty or physically heavy work needs longer. Ask at your first follow-up visit.
Is pterygium surgery covered by insurance?
Pterygium removal with a conjunctival autograft is among the procedures that can be handled as a cashless claim at the hospital, depending on your policy. Send the name of your insurer or TPA before your visit so that your policy can be checked.
Related pages
Appointments and contact
You can reach Dr. P. Siva Reddy Eye Hospital on WhatsApp or by phone during OPD hours.
OPD hours: Monday to Saturday, 10 AM to 2 PM and 4:30 PM to 7 PM. Closed on Sunday.