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Symptoms
- May be asymptomatic or only cosmetically disturbing
- Redness, foreign body sensation, change in refraction, visual impairment
Findings
- Typically nasal (also temporal) fibrovascular tissue extending from conjunctiva to cornea
- Punctate lesions of conjunctiva/cornea, adjacent corneal indentation, iron line (Stocker line)
- Refraction: increased astigmatism
Differential Diagnoses
- Carcinoma in situ (CIN): papillomatous, gelatinous, whitish tissue growth
- Other conjunctival tumors
- Pingueculum: limited to the conjunctiva, cornea not affected
- Pannus
Work-up
- Visual acuity and refraction: Astigmatism?
- Slit lamp examination (how many mm from the limbus?), photodocumentation
- Signs of malignancy? (Leukoplakia, gelatinous mass, papillomatous, prominent feeder vessels)
- Is motility restricted?
Medical Treatment
- UV protection, protection against wind and dust
- Intensive lubrication with drops and ointments, especially if punctate epithelial keratoconjunctivitis or dellen is present
- Red eye: FML Liquifilm gtt 4x/day for 2 weeks (no long-term therapy), alternatively Acular gtt (Ketorolac) 3-4x/day, in case of itching consider Zaditen SDU 2x daily
Surgery
- Main indications:
- Visual axis affected or endangered
- Visual impairment due to pronounced astigmatism
- Restricted motility
- Suspected dysplasia/malignancy
- Documented growth
- Other indications:
- Growth described by the patient
- Severe complaints without improvement with drops
- Cosmetically disturbing
- Consider before cataract surgery
- Operation: Pterygium excision with free conjunctival graft (+/- Mitomycin C / 5-FU)
- Postoperative contact lens to reduce discomfort
Postoperative Management
- Contact lens in place for 10-14 days
- Tobrex gtt or Floxal UD 4x/day (at least as long as the contact lens)
- Dexafree UD initially every 1-2 hours, then taper slowly
- Treat for a minimum of 2-3 months, reduces recurrence rate!
- Initial fixed pain medication (e.g., with paracetamol/ibuprofen)
- Follow-ups after 1 day, (2 weeks), 1 month, 3 months, 1 year
- Is the contact lens in place? Is the graft in place? Infections? Recurrences? Corneal ulcer? Intraocular pressure?
Sources
- Hall AB. Understanding and managing pterygium. Community Eye Health. 2016;29(95):54-56.
- EyeWiki Pterygium
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)