You thought you were done with it yet there it is again, lurking out the corner of your eye like a mouse you thought you had gotten rid of. Though rodents aren’t a common comparison for pterygia, they do share a similarity in that they can be more difficult to get away from than you’d like.
Pterygia
A pterygium (plural pterygia) is a fleshy white or yellowish wing-shaped overgrowth on the eye, originating from the whites and extending over the cornea (the transparent dome covering the colored iris). Pterygia are an exceedingly common finding, more frequently found in individuals who are subject to prolonged sun and UV exposure, such as surfers, farmers, and populations in equatorial nations.
Though unsightly, pterygia are considered to be benign and non-cancerous. However, there is some overlap between the characteristics of a pterygium and other UV-related malignant tumors of the eye. Additionally, research has found a link between pterygia and an increased risk of melanomas on the skin.
An early pterygium is not likely to cause many issues. In fact, you probably wouldn’t even realize you have a pterygium until your eyecare practitioner points it out to you. However, as the pterygium grows and extends further over the cornea, you may find your vision becoming distorted and blurred. Other symptoms of a pterygium include:
- Redness and inflammation of the pterygium
- Irritation and a burning sensation of the eye
- The sensation of a foreign particle in the eye
- Increasing astigmatism, leading to distortion and blur of your vision
- Increased glare sensitivity and haloes around lights
Treatment of a Pterygium
If the pterygium is quiet (like a well-behaved mouse) and not bothering you, it’s completely fine to just co-exist together. During flare-ups of inflammation, your eye doctor can recommend lubricants to soothe and protect the surface of the eye, or an anti-inflammatory medication, such as steroid eyedrops. However, if the pterygium is becoming more intrusive and interfering with your vision, it’s time to call for pest control.
Surgery with an ophthalmologist (eye specialist) is the only definitive treatment to remove a pterygium. There are several different techniques that have been used over the years for this, though all are based on the same basic step of snipping off the pterygium tissue, with or without the addition of further therapy in an attempt to minimize the pterygium regrowing.
Techniques such as the bare sclera technique, which involves simply surgically removing the pterygium and allowing the bare excision site to heal on its own, are associated with recurrence rates reported as high as 89%. If combined with the application of certain chemical agents, such as mitomycin C or fluorouracil, the likelihood of that pesky pterygium returning can be significantly lowered.
The bare sclera technique is infrequently used nowadays in favor of more advanced surgical methods, which come with lower recurrence rates. For example, a limbal conjunctival autotransplant takes a patch of healthy conjunctiva (the transparent membrane covering the whites of the eye) with a bit of corneal tissue, and is placed over the excision site once the pterygium has been removed. The risk of recurrence with this method varies across different studies but several have reported recurrence rates as low as 1-5%.
What Causes a Pterygium to Recur After Surgery?
The million-dollar question – unfortunately, doctors are still looking for the million-dollar answer. We do, however, have some insight into the risk factors that can increase the likelihood of a pterygium recurring after surgery. Here are some of the factors we know about so far:
- Genetics. Hereditary factors are known to play a role in the initial development of a pterygium, particularly the genes relating to inflammation and cell growth. Some studies have also discovered certain genetic mutations carry an increased risk of a recurrent pterygium after surgery.
- Younger age. Individuals under the age of 45 years have a 3.5 times increased risk of their pterygium returning after removal. This is thought to potentially be due to a more vigorous healing response in younger bodies, and higher rates of outdoor activity.
- Ocular surface inflammation. Inflammatory conditions on the surface of the eye can predispose an individual to pterygium development. Such conditions include blepharitis (inflammation of the eyelids), rosacea (an inflammatory skin condition that can also affect the eyes), meibomian gland dysfunction (disorder of the oil glands within the eyelids, causing dry eye), or keratitis (inflammation of the cornea).
- Ethnicity. African American and Hispanic heritage has been linked with an increased risk of pterygium recurrence.
- Gender. Though studies are inconclusive, there is some suggestion that male gender is associated with both initial pterygium development and also recurrence after surgery.
- Pterygium surgery factors. As discussed earlier, different surgical methods are associated with varying rates of recurrence. For example, if your eye surgeon tells you they’re going to do the bare sclera technique and that’s the end of that, find yourself another surgeon. In the same vein, surgeon experience and skill are likely to play a role in minimizing pterygium recurrence after surgery. The more pterygium operations a patient has had in the past has also been correlated with an increased likelihood of the pterygium returning.
Pterygium Surgery at Ventura County LASIK
Though there’s not much you can do about your genetics, age, ethnicity, or birth gender to reduce your pterygium risk, you can maximize your chance of a pterygium-free life by choosing the right eye surgeon.
Dr. Franz Michel is one of the most renowned pterygium surgeons around the world with a consistent recurrence rate of less than 1%, even accepting referrals from other eye specialists for challenging pterygium cases. Using the conjunctival limbal autograft technique, Dr. Franz Michel has successfully removed thousands of bothersome pterygia for patients across Ventura County and Los Angeles.