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News and Updates

Pterygium

By Dr Robyn Armstrong, Spring 2006

Definition:

A fibrovascular growth of the conjunctiva, which encroaches onto the cornea, usually located nasally.

Image of an eye showing an example of Pterygium

Pinguecula Definition:

A benign yellow/white thickening in the interpalpebral nasal or temporal bulbar conjunctiva. Rarely requires treatment.

Aetiology:

Although a genetic predisposition is likely, adverse atmospheric factors such as UV light, dust and wind are associated with increased incidence.

Prevalence:

This varies with age, sex of patient (male > female), UV light exposure occupation, environment and location. There is a higher prevalence in places of lower latitude and in high UV exposure countries, eg Australia.

Management:

This should be directed to prophylaxis with the wearing of a brimmed hat and sunglasses with 100% UV light absorption.

Indications for Surgery:

  • A threat to vision:
  • The pterygium may impinge on the visual axis.
  • Astigmatism: there is flattening of the cornea in the longitudinal axis of the pterygium.
  • Persistent irritation and redness.
  • Contact lenses: Pterygia must be excised in order to wear soft contact lenses successfully.
  • Cosmesis.

At the MetWest Eye Centre a specialist anaesthetist administers IV sedation and induces ocular anaesthesia with a peribulbar injection. This procedure is painless.

Surgical Procedure:

After removing the pterygium with its underlying subconjunctival fibrovascular tissue, a conjunctival autograft (from the superior bulbar conjunctiva) is placed over the conjunctival defect and secured by sutures. This graft acts as a physical barrier to regrowth.

Post-operative Management:

The eye is padded for 48 hours, then antibiotic and steroid drops are instilled for three weeks. Discomfort is well controlled by simple analgesics such as paracetamol.

Complications:

Recurrence with the above technique is <5% but of the order of 50% if conjunctival grafting is not performed. Infection, haemorrhage and granulomatous formation are rare.

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