Pterygium is a triangular growth of conjunctival tissue that extends onto the cornea. It is caused by prolonged sun exposure and is more common in older males working outdoors. Symptoms include irritation, foreign body sensation, and decreased vision. Treatment options include conservative measures like artificial tears or surgical excision with conjunctival autograft to prevent recurrence. Surgery involves removing the pterygium tissue from the cornea and replacing it with a conjunctival graft taken from the patient's eye. Post-operative care and monitoring for recurrence is important.

1. PTERYGIUM
Dr Jeel Garala
Ophthalmology Dept
CU Shah Medical college

2. DEFINITION
 PTERYGIUM is a triangular encroachment of the vascularized granulation
tissue covered by conjunctiva in the interpalpebral area.
 It is the degenerative condition of the conjunctiva.

3. ETIOLOGY
 Pterygium is a response to prolonged effect of environmental factors such as:
• Exposure to sun (ultraviolet rays)
• Dry heat
• High wind
• Abundance of dust

4. PATHOGENESIS
 Pterygium is degenerative and hyperplastic condition of conjunctiva.
 The subconjunctival tissue undergoes elastotic degeneration and proliferates
as vascularised granulation tissue under the epithelium.
 It ultimately encroaches the cornea.
 It destroys the superficial layers of stroma and bowman’s membrane.
 Formation of dense fibrous tissue leads to development of corneal
astigmatism.

5. CLINICAL FEATURES
(1) DEMOGRAPHY:
• Age: Usually common in old age.
• Sex: more common in males doing outdoor work than females.
• It is usually bilateral and more common on nasal side.

6. CLINICAL FEATURES
(2) SYMPTOMS:
• Foreign body sensation
• Irritation
• Diminution of vision as it encroaches the pupillary region of cornea and due to
corneal astigmatism.
• Cosmetic intolerance
• Diplopia

7. CLINICAL FEATURES
 (3) SIGNS:
• Triangular fold of conjunctiva encroaching the cornea.
• Parts of fully developed pterygium are:
 Head- Apical part present on the cornea.
 Neck- Constricted part present in the limbal area.
 Body- Scleral part extending between the limbus and canthus.
 Cap- Semilunar whitish infiltrate just present in front of the head.

8. TREATMENT
 CONSERVATIVE:
• Artificial tears
• Protective moisture retaining glasses
• Punctal occlusion
• Topical and systemic steroids
• Dapsone
• Immunosuppressive therapy

9. TREATMENT
 SURGICAL: Indications for surgery-
• Cosmetic disfigurement
• Recurrent irritation, redness & watering
• Visual impairment
• Continued progression threatening to encroach onto the pupillary area
• Diplopia due to interference in ocular movements
• Motility restriction
• Suspected associated neoplastic degeneration

10. SURGICAL METHODS
 Surgical excision with free conjunctival limbal autograft(CLAU)
 Surgical excision with amniotic membrane graft and mitomycin-C (MMC)
 Surgical excision with lamellar keratectomy and lamellar keratoplasty

11. PREOPERATIVE MANAGEMENT
 A detailed history is taken and slit lamp examination done preoperatively and
appropriate grading should be done
 Past history of similar complain should be noted
 History of recurrence is asked as there is a risk of fibrosis due to previous
surgery
 Occupation history should be noted
 Acute inflammed condition should be ruled out and managed medically first
and the patient should be advised for surgery in follow up

12. PREOPERATIVE MANAGEMENT
 Blood pressure
 Routine blood investigations
 CBC
 RBS
 Urine – R & M
 HIV & HBsAg
 Antiplatelet medication should be stopped as per physician & anesthetist
advice
 Obtain an informed & written consent

13. Anesthesia
 The surgery can be done under local anesthesia – Peribulbar block or can also
be done under topical anesthesia if the patient is cooperative
 Anesthetist should be stand by if the patient is having any cardio-respiratory
or any other systemic abnormality

14. Procedure
 After anesthesia is given, painting and draping of the affected eye is done
 Head of the pterygium is avulsed from the cornea in a centrifugal manner
 Corneal scrapping done with 15 no. knife or crescent knife

15. Procedure
 Subconjunctival Tenon’s tissue is separated
 Head of the pterygium is cut and hemostatis is achieved

16. Procedure
 Conjunctival autograft is taken from the superior aspect or the
superotemporal aspect
 Conjunctival autograft is rotated and placed on the bare sclera

17. Procedure
 The graft is sutured with the conjunctiva with vicryl 8-0/9-0 suture
 Double pad bandage done with antibiotic moxifloxacin & CMC(0.5%) eye drops

18. Procedure
 If the surgery is done with fibrin glue – then the preparation of the glue
should be done prior to surgery
 The refrigerated components of the glue are allowed to settle at normal room
temperature 30 mins prior to surgery or put in a lukewarm saline for 20-30 min
 The component A & B are prepared under aseptic precaution in different syringes
indicated as per the manufacturer
 Both syringes should be marked accordingly & put in the trolley prior to surgery
 The Component A & B should be applied over the bare sclera one after the
another and then the CAG is placed over the sclera within 5-10 seconds
 Double pad bandage is done without any topical medications

19. Procedure
 The amniotic membrane should also be used in stead of CAG & topical
mitomycin – C is advised to prevent the recurrence

20. Complications
 Intraoperative
 Puncture wound in the body of pterygium while dissecting the Tenon’s tissue
 Injury to the medial rectus due to over dissection of the Tenon’s tissue
 Injury to the superior rectus while taking the CAG superiorly
 Injury to the cornea while scrapping

21. Complications
 Postoperative
 Displacement of the graft from the original position
 Extensive subconjunctival haemorrhage due to poor handling of tissue during surgery
 Graft oedema
 Granuloma formation
 Scleritis
 Persistent epithelial defect
 Dellen
 Endophthalmitis
 Late postoperative
 Opacification over cornea
 Recurrence

22. Thank you
 Reference :
 Kanski’s clinical ophthalmology – 9th edition