Pterygium

Question 1

Aetiology

Answer 1

Winged-shaped fibrovascular growth from bulbar conjunctiva into cornea. Multifactorial aetiology but generally attributed to chronic UV exposure, dust and wind.

Question 2

Predisposing factors

Answer 2

Male
Age
Long term UV exposure - sunlight, dust and wind
Dry arid climate
Inflammatory and allergic ocular conditions

Question 3

Symptoms

Answer 3

Cosmetic concerns
Redness, irritation, FB sensation
Blurred vision - due to induced astigmatism
In severe cases, can extend over visual axis

Question 4

Signs

Answer 4

Asymmetric, nasally, bilateral
Starts with scarring, thickening, distortion of bulbar conjunctiva. Grey opacities appear near limbus. Conjunctiva overcomes these opacities and grows over the limbus into the cornea, destroying Bowman’s layer and superficial stromal lamellae.
Stockers line - epithelial iron deposit in front of pterygium
Flattening of cornea in horizontal meridian
Rich surface vascularisation
tear film instability

Question 5

Non-pharmacological management

Answer 5

Protection from UV - sunglasses, brimmed hat
Cold compresses when inflamed
Photodocument

Question 6

Pharmacological management

Answer 6

Lubricants and ointment
Short course of steroid if inflamed

Question 7

Refer?

Answer 7

Not usually
Consider routine referral if: threatening visual axis, cosmetically unacceptable, irregular astigmatism, chronic inflammation

Question 8

What can they do at hospital?

Answer 8

Excision via various surgical techniques
- Conjunctival autografting, limbal-conjunctival autografting, amniotic membrane grafting

Post op beta irradiation or topical thiotepa.
intralesional injection of bevacizumab
mitomycin C intra or post op.