Pinguecula and pterygium are benign growths of the conjunctiva that can result from chronic actinic irritation. Both typically appear adjacent to the cornea at the 3-o’clock position, the 9-o’clock position, or both.
(See also Overview of Conjunctival and Scleral Disorders.)
Pinguecula and Pterygium
Pinguecula and pterygium are benign conjunctival growths that can result from chronic actinic irritation. Pinguecula (left) is accumulation of conjunctival tissue at the nasal or temporal junction of the sclera and cornea. Pterygium (right) is conjunctival tissue that becomes vascularized, invades the cornea, and may decrease vision due to obstruction or induced astigmatism. |
Pinguecula
A pinguecula is a raised, yellowish white mass within the bulbar conjunctiva, adjacent to the cornea and usually occurring at the 3- and 9-o'clock meridians. It is benign and does not affect vision. A pinguecula does not tend to grow onto the cornea.
Pingueculae are usually asymptomatic but may cause cosmetic blemish or irritation if elevated or inflamed.
Although rarely necessary, pingueculae can easily be removed and typically do not recur.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Pterygium
A pterygium is a fleshy triangular growth of bulbar conjunctiva, occurring only at the 3 and 9 o'clock meridians of either eye, usually not simultaneously. It is benign but may spread across and distort the cornea, induce astigmatism, and change the refractive power of the eye, affecting vision.
Symptoms may include decreased vision and foreign body sensation. It is more common in sunny, hot, dry climates.
Paul Whitten/SCIENCE PHOTO LIBRARY
To relieve symptoms caused by a pterygium, artificial tears or a short period of treatment with corticosteroid drops or ointments may be prescribed. Growth of a pterygium may be slowed by using a hat that shields the eye from ultraviolet (UV) sunlight and by adding a UV block coating to glasses and sunglasses. To relieve symptoms caused by a pterygium, artificial tears or a short period of treatment with corticosteroid drops or ointments may be prescribed. Growth of a pterygium may be slowed by using a hat that shields the eye from ultraviolet (UV) sunlight and by adding a UV block coating to glasses and sunglasses.
Removal is often indicated for documented growth, cosmesis, to reduce irritation, and to improve or preserve vision. Antimetabolites such as mitomycin and 5-fluorouracil (5-FU) have been used effectively intraoperatively and postoperatively to decrease recurrence rates (Removal is often indicated for documented growth, cosmesis, to reduce irritation, and to improve or preserve vision. Antimetabolites such as mitomycin and 5-fluorouracil (5-FU) have been used effectively intraoperatively and postoperatively to decrease recurrence rates (1), but they have a high complication rate, including scleral and corneal melting. Subconjunctival injections of an anti-VEGF medication (eg, bevacizumab) under a pterygium may be useful to prevent progression and improve outcomes when used with pterygium excision plus conjunctival autograft and to treat recurrent pterygium (), but they have a high complication rate, including scleral and corneal melting. Subconjunctival injections of an anti-VEGF medication (eg, bevacizumab) under a pterygium may be useful to prevent progression and improve outcomes when used with pterygium excision plus conjunctival autograft and to treat recurrent pterygium (2). The technique with the best results to prevent recurrence is pterygium excision followed by conjunctival autograft.
Pterygium references
1. Bekibele CO, Ashaye A, Olusanya B, et al. 5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence. Int Ophthalmol. 2012;32(1):3-8. doi:10.1007/s10792-011-9509-x
2. Sun Y, Zhang B, Jia X, Ling S, Deng J. Efficacy and Safety of Bevacizumab in the Treatment of Pterygium: An Updated Meta-Analysis of Randomized Controlled Trials. J Ophthalmol. 2018;2018:4598173. Published 2018 Sep 5. doi:10.1155/2018/4598173
