Definition

Pterygium or Surfers eye, is a fleshy, elevated, triangular or wedge-shaped encroachment of a

pinguecula onto the cornea, usually on the nasal side bilaterally. It is a benign growth that might spread
slowly during a persons life or stop after a certain point. In extreme cases, it can cover the pupil and
cause vision problems. It can also permanently disfigure the eye. The growth can be in one eye or both.
When both eyes are affected, it is known as bilateral pterygium.

Causes and Risk Factors

The exact cause of pterygium isnt known. One explanation is that too much exposure to ultraviolet (UV)
light can lead to these growths. It is thought to be an irritative phenomenon due to ultraviolet light,
drying, and windy environments. The predominance of pterygia on the nasal side is possibly a result of
the sun's rays passing laterally through the cornea, where it undergoes refraction and becomes focused
on the limbic area. Sunlight passes unobstructed from the lateral side of the eye, focusing on the medial
limbus after passing through the cornea. On the contralateral (medial) side, however, the shadow of the
nose medially reduces the intensity of sunlight focused on the lateral/temporal limbus.

Epidemiology

It is common in persons who spend much of their lives outdoors, in sunny, dusty, or sandy, windblown
surroundings. It commonly affects those that live near the equator and in persons aged 20 to 40 years,
and are twice as likely to occur in men than women. But it can affect anyone who lives in a sunny place.
Persons having light skin and light eyes are at increased risk of getting a pterygium.

Pathologic findings

The pathologic findings are the same as those of pinguecula which are composed of hyaline and elastic
tissue. In the cornea, there is replacement of Bowmans layer by hyaline and elastic tissue.

Pterygium in the conjunctiva is characterized by elastotic degeneration of collagen (actinic elastosis) and
fibrovascular proliferation. It has an advancing portion called the head of the pterygium, which is
connected to the main body of the pterygium by the neck. Sometimes a line of iron deposition can be
seen adjacent to the head of the pterygium called Stocker's line. The location of the line can give an
indication of the pattern of growth.

The pterygium is composed of several segments:

Fuchs' Patches (minute gray blemishes that disperse near the pterygium head)
Stocker's Line (a brownish line composed of iron deposits)
 Hood (fibrous nonvascular portion of the pterygium)
Head (apex of the pterygium, typically raised and highly vascular)
Body (fleshy elevated portion congested with tortuous vessels)
Superior Edge (upper edge of the triangular or wing-shaped portion of the pterygium)
Inferior Edge (lower edge of the triangular or wing-shaped portion of the pterygium)

Signs and Symptoms

Before it appears, some patients notice a related condition called pinguecula. This is a yellowish nodule
on the conjunctiva. A pterygium doesnt always cause symptoms. When it does, the symptoms are
usually mild. Common symptoms include foreign body sensation, itchiness, burning feeling, and redness
of the eyes. If the growth encroaches to the pupillary area, it could change the shape of the cornea and
cause blurring of vision. It can distort the shape of the front surface of the eye, causing astigmatism and
higher-order aberrations that affect vision.

Diagnosis

Diagnosing a pterygium is straightforward. Based on a physical examination using a slit lamp, the
physician can visualize the eyes. Additional tests, if needed, include a visual acuity test, corneal
topography (used to measure curvature changes in your cornea), and photo documentation (taking
pictures to track the growth rate of the pterygium).

Management

If the symptoms are mild, treatment is not necessary. If there is temporary redness or irritation, artificial
tears or prescription steroid eye drops are beneficial. Regardless of severity, pterygia should be
monitored to prevent scarring that could lead to vision loss. If the pterygium is enlarging and encroaches
on the pupillary area, it should be removed surgically along with a small portion of the superficial clear
cornea beyond the area of encroachment. The complications of surgery include return of a more
aggressive growth, scars on the cornea, and blurring of vision from an uneven cornea (astigmatism).
However, the most common reason for pterygium excision is for cosmetic reasons.

Recurrence

Unfortunately, pterygia often return after surgical removal, possibly due to oxidative stress and/or
continued UV exposure. Some studies show recurrence rates up to 40 percent, while others have
reported recurrence rates as low as 5 percent. Some research even shows higher rates of recurrence in
those who have pterygia removed during the summer months, potentially because of their increased
exposure to sunlight.
To prevent regrowth after a pterygium is surgically removed, eye surgeon often suture or glue a piece of
surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, has
been shown to safely and effectively reduce the risk of pterygium recurrence.

A drug that can help limit abnormal tissue growth and scarring during wound healing, such as mitomycin
C, also may be applied topically at the time of surgery and/or afterward to reduce the risk of pterygium
recurrence.

After removal of the pterygium, some physicians prescribe steroid eye drops for several weeks to
decrease swelling and prevent regrowth. In addition to using your drops, it's very important to protect
the eyes from the sun with UV-blocking sunglasses after surgery, since exposure to ultraviolet radiation
may be a key factor in pterygium recurrence.

Prevention

Wearing of sunglasses everyday helps prevent the tissue growth. That includes overcast days -- clouds
dont stop ultraviolet (UV) light. Shades that block 99%-100% of both ultraviolet A (UVA) and ultraviolet
B (UVB) radiation should be used.

Wraparound styles provide the best shield against ultraviolet light, dust, and wind. Wear the glasses
even in the car since unlike the windshield, a cars side windows dont protect against UV rays.
Protective film can also be applied to the side windows to help.

Experts say to choose a hat with a brim to protect the eyes from UV light. The use of artificial tears can
also help to keep the eyes moist in dry climates.