Pterygium

Disease Description (Causes and Symptoms)

• Definition and pathophysiology
  • A chronic disease in which fibrovascular tissue of the conjunctiva (the white of the eye) proliferates and infiltrates from the conjunctiva toward the cornea in a triangular shape. Chronic irritation and inflammatory responses on the conjunctival and corneal surfaces caused by ultraviolet (UV) exposure are the main mechanisms, resulting in fibrovascular proliferation.
• Main causes
  • Excessive ultraviolet exposure (major risk factor), wind, dust, dry environments, occupations involving frequent outdoor activity, and genetic predisposition.
• Symptoms
  • Often asymptomatic in the early stages.
  • Redness, foreign-body sensation and grittiness, dryness, and intermittent pain (during inflammation).
  • As the lesion enlarges, it can deform the corneal surface and cause astigmatism; if it progresses toward the pupil, vision loss may occur.
  • Redness may become more pronounced after fatigue or bathing/showering.

Treatment Methods (Including the Latest Standard Treatments and Precautions)

• Conservative (non-surgical) treatment
  • Symptom relief: use artificial tears (lubricants), improve the environment (UV protection and wearing protective eyewear), and use eye drops for temporary relief of redness.
  • Inflammation control: if acute inflammation is severe, short-term topical steroid eye drops may be used (as directed by a doctor); anti-inflammatory drugs (e.g., topical nonsteroidal drugs or immunomodulators) may be used selectively.
• Surgical treatment (indications)
  • When it causes vision loss (involvement of the visual axis), induces severe astigmatism, is progressive, or removal is desired for cosmetic or functional reasons.
• Surgical techniques and adjunctive treatments
  • Standard: excision of the lesion followed by covering the exposed sclera with a conjunctival autograft (low recurrence rate).
  • Alternative: amniotic membrane transplantation (in some cases), used when conjunctival grafting is difficult.
  • Adjunct to reduce recurrence: topical or intermittent low-concentration mitomycin C (MMC) (used during or after surgery, taking susceptibility and complications into consideration).
  • Anesthesia: usually performed under local (regional) anesthesia.
• Postoperative management
  • Antibiotic and steroid eye drops, pain and inflammation management, and regular follow-up (monitoring for recurrence).
  • Recovery period: appearance and symptoms generally improve within several weeks; changes in vision and astigmatism vary between individuals.
• Precautions and risk of complications
  • Simple excision followed by leaving the sclera exposed has a very high recurrence rate → an appropriate covering, such as an autograft, is necessary.
  • Complications: recurrence, vision loss and astigmatism due to scarring, infection, rarely scleral melting (particularly when MMC is used), and strabismus due to restricted eye movement.
  • The possible adverse effects of surgery and medications (steroid side effects, MMC-related complications, etc.) should be explained in advance.

Checklist Before an Outpatient Visit (Including Items to Prepare and Examples of Records and Questions)

• Items to prepare and records to bring
  • A list of all medications currently being taken (including eye drops) and a history of allergies.
  • A history of previous eye surgery or trauma and whether contact lenses are used.
  • Information related to occupation (frequency of outdoor activity) and amount of UV exposure.
  • Recent changes in vision, the timing and frequency of redness and pain, and photographs showing whether the lesion has grown (if possible).
• Items that are useful to record in advance
  • When symptoms began, situations that worsen them (fatigue, exposure to water or wind, etc.), when vision loss began and its impact on daily life, and home treatments used (medications).
• Example questions to present during an outpatient visit (for patients)
  • “When did the symptom that concerns you most begin?” → Useful for diagnosis.
  • “Are there environments, such as sunlight or wind, that worsen your symptoms?” → Incorporated into the prevention and treatment plan.

General Example Questions to Ask the Doctor

• How quickly is this disease progressing, and what is my individual prognosis? How likely is recurrence?
• Do you think surgery is necessary, and when? Are there cases that can be managed without surgery?
• What are the surgical methods (conjunctival autograft versus amniotic membrane, etc.), and what are the advantages and disadvantages of each?
• How long will recovery take, and when can I resume daily activities (driving, work, and wearing contact lenses) after surgery?
• What are the main side effects and precautions for the prescribed medications (especially steroids and MMC)?

Examples of Disease-Specific Questions

• Is my lesion currently involving the visual axis (pupil)? How likely is vision loss to improve with surgery?
• I work outdoors. What protective equipment (such as specific sunglasses or protective eyewear) or lifestyle habits are recommended to reduce recurrence after surgery?

Reviewed: This information is general guidance organized on the basis of typical medical recommendations and evidence. Please follow the advice of your treating specialist for individual diagnosis and treatment.