Pterygium

A pterygium (say "ter-RIDGE-ee-um") is a pink, fleshy, wing-shaped growth on the white of the eye. It usually starts on the side nearest the nose and slowly grows onto the cornea, the clear window at the front of the eye [1]. It can affect one or both eyes.

A pinguecula (say "pin-GWEK-you-la") is a small yellowish bump on the white of the eye that does not grow onto the cornea. It is very common and usually harmless [1].

Image to add

Close-up drawing of an eye with a pink, triangular fleshy growth spreading from the inner corner onto the clear cornea. Alt text: "Drawing of an eye with a pterygium, a pink wing-shaped growth from the corner near the nose spreading onto the cornea."

What causes it?

Both are linked to long-term exposure to [1][2]:

• sunlight (UV light), the biggest cause
• wind, dust and sand
• dry eyes

They are more common in people who live in hot, sunny countries near the equator, and in people who work outdoors, such as fishermen, farmers and construction workers [2]. A pterygium is sometimes called "surfer's eye".

Many people have no symptoms apart from noticing the growth in the mirror. You may have [1]:

• a red, fleshy patch on the white of the eye
• eyes that feel gritty, dry, itchy or irritated
• eyes that get red and sore now and then, especially after sun, wind or dust
• blurred vision, if the pterygium grows over the centre of the cornea or changes the shape of the cornea (astigmatism)

An eye doctor can tell you if you have a pterygium by looking at your eye with a microscope (slit lamp).

Most pterygia grow very slowly, over months to years. But some growths on the eye can look similar and need checking.

Many people do not need treatment. Your eye doctor may check it from time to time to see if it is growing [1][3].

• Lubricating eye drops (artificial tears) help the gritty, dry feeling.
• A short course of anti-inflammatory drops may be used if the eye is very red and sore. These should only be used as prescribed by a doctor.
• Surgery is advised if the pterygium is growing towards the centre of the cornea, affecting your vision, or causing a lot of discomfort.

About surgery:

• The pterygium is removed, and a thin piece of healthy tissue from under your own upper eyelid is moved to cover the area. This is called a conjunctival autograft.
• This method has a lower chance of the pterygium growing back than removing it alone [3][4].
• It is usually done as a day case, with the eye numbed.
• A pterygium can sometimes come back after surgery, so keep protecting your eyes from the sun afterwards.

Most people go home the same day. The eye heals well with good care, and following the advice below also helps stop the pterygium coming back [1][3].

Your check-up appointments

Your clinic will give you the exact dates on your appointment card. A typical plan is:

1. Day 1

   The day after surgery. The doctor removes the eye pad, checks the wound and the graft, and starts your eye drops.

2. 1 to 2 weeks

   The doctor checks that the graft is healing and staying in place, and removes stitches if needed.

3. 1 month

   The doctor checks healing and your eye pressure, and plans how to slowly reduce your drops.

4. 3 to 12 months

   Regular checks for any sign of the pterygium growing back. Most regrowth happens in the first year.

Your eye drops

• You will usually be given antibiotic drops and steroid drops. Steroid drops calm the swelling and help prevent regrowth, so they are often used for several weeks, reduced step by step.
• Do not stop early. Steroid drops can raise the eye pressure, so keep every check-up.
• Wash your hands first, and do not let the bottle tip touch your eye.

What is normal?

• A gritty, scratchy feeling for 1 to 2 weeks, especially if you have stitches.
• Redness and swelling where the pterygium was. This slowly fades over a few weeks.
• Watering and mild sensitivity to light.

Protecting your eye

• Do not rub or press the eye. Rubbing can move the graft. Wear the eye shield at night if you are given one.
• Keep water and soap out of the eye for about 2 weeks. Taking wudhu? Wipe around the eye gently with a damp hand instead of splashing the operated eye.
• No swimming for about 2 to 4 weeks, and avoid dusty, windy and smoky places.
• Wear sunglasses and a hat outdoors, now and for life, to lower the chance of regrowth.

You can lower the chance of a pterygium starting, growing or coming back after surgery [1]:

• Wear sunglasses that block 100% of UV light, ideally a wraparound style.
• Wear a wide-brimmed hat or cap outdoors.
• Protect your eyes from wind and dust, for example with goggles or safety glasses at work or when riding.
• Use lubricating eye drops if your eyes feel dry.

Where to get help in Brunei

If you notice a growth on your eye, or your eyes are often red and irritated, you can walk in to any Community Eye Clinic at your health centre. No referral is needed.