Montes Eye


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PINGUECULAE AND PTERYGIA



pingueculae and pterygia





Jorge A . Montes, MD, FACS



Long-term untreated, ocular inflammation, and ultraviolet (UV) exposure can cause many changes to the eye's skin. Some patients will develop symptoms without every forming pingueculae or ptergyia, but many will form scar tissue on the eye's surface that will continually grow. If left untreated, the changes will manifest as pinguecula, and later, a pterygium.


The two conditions lie on a spectrum with similar causes and symptoms early on.



Ocular surface dryness and UV exposure mostly occur at the 3 and 9 O' Clock positions, given that this is the area that is least covered by the eyelids. The conjunctiva, or eye's skin, in this area, is most affected. We have to pay close attention to pingueculae or pterygia that form outside this area.



PINGUECULA

Pingueculae are the earliest change noted in a chronic dry eye or an eye that has suffered longstanding unprotected UV exposure.



Symptoms

• Pain

• Redness

• Tearing

• Foreign Body Sensation

• Blurry Vision


Treatments

Pingueculae requires aggressive dry eye regimens and UV protection to decrease discomfort and prevent progression. Pingueculae also tend to undergo acute exacerbations, as seen in pingueculitis, that require topical steroids to improve symptoms.


Prognosis

Undertreated pingueculae will progress in size and will grow towards the cornea. Once they grow onto the cornea, they are known as pterygia.



PTERYGIA

Pterygia are the advanced forms of pingueculae that have crossed onto the surface of the cornea. They are very irritating and demand aggressive lubrication to prevent or stabilize symptoms.



Before Surgery



After Surgery



Symptoms

• Pain

• Redness, although more than pingueculae given their size

• Tearing

• Foreign Body Sensation

• Blurry Vision


Treatments

As with pingueculae, aggressive lubrication and UV protection are necessary to minimize symptoms and delay growth.


When medical therapy alone fails to relieve all symptoms, then surgical excision becomes an option. There are many factors to consider with this surgery. A detailed risk versus benefit discussion has to occur with your surgeon before deciding to move forward with this surgery.


Prognosis

Medical management can relieve symptoms but will not decrease the size of the pterygia. If large enough, surgery becomes an option. Recurrence rates for most pterygia surgeries are roughly 5%.


Removing the pterygia will not cure ocular dryness. It is because of dryness that pterygia exist, so removing pterygia will not eliminate dry eyes. Without adequate continued lubrication, dryness will increase the chances that a recurrence occurs. Also, after surgery, UV protection must be continued as well.





DHR Health Eye Institute



4500 North 10th Street, Suite 100, McAllen, TX 78504
Phone: 956-362-2070
Fax: 956-362-2074