Dr Ben Wild
Overview |
The conjunctiva is a clear layer of tissue that extends from the edge of the cornea, around the visible portion of the eye in front of the white sclera, and even the back surface of the eyelids. It posses as a barrier against foreign material and contributes to the tear film.
Frontal view of a healthy eye.
A pinguecula and a pterygium are two very similar ocular findings. They both represent degenerations of the conjunctiva leading to the growth of a secondary fibrous, blood vessel rich, layer.
Pingueculae are often seen bilaterally (in both eyes) as a yellowish/white mound above the nasal sides of the sclera. Sometimes they can also be found temporally. If severe, they can become inflamed (pingueculitis) or calcified. They never cross into the cornea.
Frontal view of an eye with 2 pingueculae.
A pterygium is more commonly found on people from countries near the equator. It can be found unilaterally or bilaterally, is most often seen starting from the nasal sides of each eye, but can be found temporally Pterygia look like a wing or triangle of fibrous tissue growing from the conjunctiva over the cornea.
Frontal view of an eye with a nasal pterygium.
Signs and Symptoms |
Signs
Pinguecula | Yellow/white mounds which can sometimes be inflamed found between the eyelids above the white part of the eye. |
Pterygium | Triangular fibrous growth originating from the same area as a pinguecula and continuing over the cornea. |
Symptoms
Causes and Risk Factors |
Causes
Ultra violet radiation and ocular dryness.
Risk factors
Ultra violet radiation exposure from being outside without UV-blocking glasses or sun glasses.
Prevention and Treatment |
Prevention
UV protection and address any dry eye symptoms.
Treatments
Pinguecula | · Artificial tears. · Steroid drops if inflamed (pingueculitits). · Excision (cosmetic). · Thermal laser ablation (cosmetic). |
Pterygium | · Same as above but, if the pterygium has progressed enough to cause uncorrectable vision loss, excision is no longer cosmetic. |
Prognosis |
A pinguecula is a very common finding and is considered a normal finding in most cases. In some cases, where a pinguecula has grown substantially, it requires careful management of symptoms. Very rarely does it reach a point where excision is warranted. In some cases where they are surgically removed, they can be recurrent. It is not vision threatening.
A pterygium is only vision threatening if it grows far enough into the cornea . Most do not reach this stage. Excision surgery does not usually remove 100% of the tissue and therefore the patient is often left with some irregular astigmatism that cannot be fully corrected with glasses. Sometimes these can recur after surgery.
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