Pterygium Surgery

What is a pterygium?

A pterygium is a fleshy, wedge-shaped growth with visible blood vessels. It starts on the conjunctiva, the thin membrane covering the white of the eye, and slowly creeps onto the cornea, the clear window at the front. It usually appears on the side nearest the nose and can affect both eyes. It is benign, but as it moves further across the cornea it can start to interfere with vision.

Ultraviolet (UV) light from the sun is the main trigger, which is why it is sometimes called surfer’s eye. Wind, dust and dry air keep the surface of the eye irritated and make things worse. People who work outdoors or live in sunny, windy climates develop it more often.

A pinguecula looks similar at first glance: a yellowish bump on the conjunctiva that stays there and does not grow onto the cornea. A look through a slit-lamp microscope is enough to tell the two apart.

When does a pterygium need surgery?

A small pterygium that has stayed the same size for years does not always need an operation. Lubricating drops and sunglasses are often enough, with a short course of anti-inflammatory drops when it flares up. Drops relieve symptoms, though they will not make the tissue smaller.

Surgery is usually considered when:

• the pterygium is moving towards the centre of the cornea, in line with your vision
• it pulls on the cornea and causes astigmatism, blurring your sight
• redness, burning, stinging or a gritty feeling persists despite drops
• it has grown noticeably in a short time
• it has come back after previous surgery
• it makes contact lenses uncomfortable or impossible to wear
• its appearance bothers you

Timing matters for the result. The further the tissue has spread across the cornea, the more visible the scar it can leave behind once removed. A pterygium approaching the pupil is therefore not left for long.

What happens at the examination?

Using the slit lamp, the doctor measures how many millimetres the pterygium has advanced onto the cornea, how thick it is and how many vessels it carries. Corneal topography maps the shape of the corneal surface. It shows whether the pterygium has caused astigmatism, meaning the cornea curves more steeply in one direction than another. Tear film tests check for dry eye, which can worsen symptoms and slow healing after surgery.

If you are also planning cataract or laser surgery, the order of treatment needs discussing. A pterygium on the cornea can distort the measurements used to calculate lens power or plan laser treatment. In that case the pterygium is usually removed first, and the measurements are repeated once the cornea has settled. Assoc. Prof. Dr. Elif Ceren Yeşilkaya decides the sequence based on what the examination shows.

How is pterygium surgery done?

The pterygium is lifted off the cornea and conjunctiva and removed, and the corneal surface is smoothed. The bare area left behind is then covered. During the operation you may feel touch or pressure.

Why a conjunctival autograft reduces regrowth

If the pterygium is cut away and the area is left bare, blood vessels grow back into the gap and the tissue often returns. With a conjunctival autograft, a thin piece of healthy conjunctiva is taken from under your upper eyelid and placed over the area where the pterygium was. Because it is your own tissue, there is no risk of rejection. The graft is held in place with fine stitches or tissue glue. The donor site heals by itself and stays hidden under the lid.

A pterygium that has already come back after surgery may need a more extensive plan, which is discussed at your examination.

Preparing for the day of surgery

Tell the doctor at your examination if you take blood thinners or any other regular medicine. Whether to pause a medicine is decided together with the doctor who prescribed it. Your eye may be covered after the operation, so do not drive, and bring someone with you.

Looking after your eye after surgery

• Redness, stinging, watering and mild aching are expected in the early days. If stitches were used, the eye may feel as though something is in it.
• Use the antibiotic and steroid drops as prescribed. Steroid drops can raise eye pressure in some people, so it is measured at your check-ups.
• The redness fades gradually as the graft settles.

While the eye heals, avoid rubbing it, wash your hands before putting in drops and keep every follow-up appointment. Your doctor sets the dates of your check-ups.

Sun protection after surgery

The conditions that caused the pterygium have not gone away, and UV exposure is one of the factors that raises the chance of regrowth. Wear sunglasses with a UV filter whenever you are outdoors. Close-fitting, wraparound frames also keep out wind and dust, and a wide-brimmed hat adds further protection. UV passes through cloud, so wear the glasses on overcast days too.

Regrowth usually shows up in the first few months as new redness and vessels at the same spot, reaching towards the cornea. If you notice this, book an appointment without waiting for your next scheduled check.

Risks and when to seek help

The most common problem is the pterygium growing back. Other possible complications include swelling, shifting or shrinking of the graft, a scar on the cornea, redness at the surgical site that lasts longer than expected and, rarely, infection.

Seek help promptly if pain gets steadily worse after surgery, your vision drops suddenly, the redness spreads or you notice thick discharge from the eye.

Assessment takes place at Medicana Zincirlikuyu (Şişli, Istanbul). A slit-lamp examination and corneal topography show how far the pterygium has advanced and whether it is causing astigmatism, and the decision on surgery and its timing is based on those findings.