Pterygium (Surfer’s Eye) and Pinguecula Surgery

Pterygium surgery with conjunctival autograft — with Dr. Nejmi Öztürk, ophthalmologist and eye surgeon, at HG Hospital in Kahramanmaraş, Türkiye

What is a pterygium?

A pterygium (popularly known as “surfer’s eye”; “göz eti” in Turkish) is a triangular growth in which the thin membrane covering the white of the eye (the conjunctiva) thickens and grows onto the clear front layer of the eye, the cornea. It usually starts on the side nearest the nose and progresses slowly over the years. Because it contains blood vessels it looks red; as it grows it pulls on the cornea and causes astigmatism, and when it reaches the visual axis it reduces vision. A pterygium is not a tumour and is not contagious.

The difference between a pterygium and a pinguecula

A pinguecula is a small yellowish-white bump on the conjunctiva next to the cornea; it does not grow onto the cornea. From time to time it becomes red and gritty, but it does not affect vision and usually does not need surgery. A pterygium, on the other hand, is a vascular, progressive tissue that advances across the cornea. Both are linked to the same environmental factors.

What causes a pterygium?

The main cause of a pterygium is exposure over many years to the sun’s ultraviolet (UV) rays, dust and wind. It is therefore more common in people who work in farming, construction and outdoors, and in sunny, dusty climates; it is frequently seen in patients who work in agriculture and outdoor jobs in Kahramanmaraş and its districts. The dustier environment after the earthquake is another factor that can increase irritation of the eye surface. Dry eye and a family history of pterygium raise the risk.

What are the symptoms? Who is surgery suitable for?

The most common symptoms of a pterygium are redness, stinging and burning, a feeling of sand in the eye, and noticing a growing piece of fleshy tissue on the nasal side of the eye.

• Redness and stinging that get worse in wind, sun and dusty surroundings
• Watering, sticky discharge in the morning
• Astigmatism and blurred vision caused by the pull on the cornea
• A marked drop in vision when the tissue approaches the pupil
• Discomfort when wearing contact lenses

Surgery is suitable for patients whose pterygium is approaching the pupil, is impairing vision by causing astigmatism, stays red and irritated despite treatment with drops, or restricts eye movement. In patients planned for cataract or laser surgery, a pterygium that distorts the measurements is removed beforehand.

Who is it not suitable for?

• People with a small, quiet pterygium: Tissue that causes no complaints and is not advancing onto the cornea is not operated on; it is monitored with artificial tears and sun protection.
• People with a pinguecula: Because it does not affect vision, removal is generally not recommended; when it becomes red, a short course of drops is enough.
• People with active inflammation of the eye surface or uncontrolled dry eye: These are treated beforehand; otherwise healing is delayed and the risk of recurrence rises.
• People with uncontrolled diabetes or an immune system problem: The general condition is brought under control beforehand so that the wound can heal.
• Patients who may need glaucoma surgery in the future: The upper conjunctiva is preserved; the graft is taken from another area or amniotic membrane is preferred.

Which examinations and tests are done?

A pterygium is diagnosed with a slit-lamp (eye microscope) examination; additional tests are done for the decision on surgery and for follow-up.

• Slit-lamp examination: The size of the tissue, how far it has advanced onto the cornea and the degree of vascularisation are assessed.
• Visual acuity and refraction: It is determined whether the astigmatism is due to the pterygium.
• Corneal topography: The distortion of curvature caused by the tissue is measured on a map of the cornea and compared before and after surgery.
• Dry eye tests: Because dry eye increases the risk of recurrence, it is treated before surgery.
• Photography: The size of the tissue is recorded so that its growth rate can be followed.

How is pterygium surgery performed?

In pterygium surgery the tissue is removed completely from the cornea and the white of the eye, and the exposed area is covered with a patch taken from the patient’s own conjunctiva (conjunctival autograft). The procedure takes about 30–45 minutes under local anaesthesia and the patient goes home the same day.

1. Anaesthesia: Anaesthetic drops are given and local anaesthetic is injected with a fine needle under the conjunctiva. Sedation is given if needed.
2. Removal of the tissue: The head of the pterygium is peeled off the cornea, and its body and the thickened tissue beneath it are separated from the white of the eye; the eye muscle is protected.
3. Smoothing the corneal surface: Rough remnants left on the cornea are cleaned away.
4. Conjunctival autograft: A thin patch is taken from the healthy conjunctiva under the upper eyelid and placed over the bare area. The patch is fixed with fine stitches or with fibrin tissue glue; when glue is used, the gritty feeling after surgery lasts a shorter time.
5. Additional measures: In a recurrent pterygium, mitomycin C may be applied briefly during surgery to reduce the chance of recurrence. If the conjunctiva is insufficient, an amniotic membrane graft may be used.
6. Dressing: Antibiotic ointment is applied and the eye is kept covered for one day.

What to expect: There is brief burning during the injection and a feeling of pressure and touch during the operation; pain is usually mild. Stinging, watering and light sensitivity are expected for a few days after surgery.

Pterygium surgery step by step

Removing the tissue that has grown onto the cornea and covering the exposed area with your own tissue.

1. Growth of the pterygiumThe conjunctival tissue grows toward the cornea in a triangular shape, most often from the nasal side. As it grows it can cause astigmatism, and if it covers the visual axis it impairs vision.
2. Removal and tissue patchAfter the tissue is removed, the exposed area is covered with a thin patch taken from the eye’s own conjunctiva. This approach lowers the chance of regrowth.
3. RecoveryThe surface closes within a few weeks. Redness may last for a while; protection from sun, dust and wind lowers the risk of regrowth.

What is recovery like?

After pterygium surgery, discomfort usually settles within 1 week and redness within 3–6 weeks.

Day 1

The dressing is removed at the examination the next day; antibiotic and steroid (cortisone) drops are started. Stinging, watering and light sensitivity are normal; sunglasses help. Do not rub the eye.

Week 1

The graft may look slightly swollen and red; this shows that it is taking. If stitches were used, the gritty feeling may last until they are removed (1–2 weeks). Stay away from dusty and windy surroundings; return to desk work after 3–5 days and to outdoor work after 1–2 weeks.

Month 1 and beyond

The redness decreases considerably; the steroid drops are tapered and stopped under the doctor’s supervision. It takes 4–8 weeks for the graft to settle fully. Because recurrence is seen most often within the first year, check-ups are planned on day 1, at week 1, month 1, month 3 and 1 year; for patients from the outlying districts, the day 1 check-up is arranged to fit into the same trip as the operation.

What are the risks and limitations?

The most important limitation of pterygium surgery is the possibility that the tissue grows back (recurrence); a conjunctival autograft reduces this risk markedly but does not eliminate it.

• Recurrence: In operations done without a graft the recurrence rate can exceed 30 percent, whereas with an autograft about 5–10 percent is reported in the literature. Young age, outdoor work and large, vascular tissue increase the risk.
• Problems with the graft: The graft may swell, shift or, rarely, fail to take; in that case it can be stitched again.
• Corneal scar and astigmatism: With tissue that has come very close to the pupil, a faint scar on the cornea and some astigmatism may remain; for this reason surgery should not be delayed too long.
• Prolonged redness: In some patients it can last 2–3 months.
• Rare risks: Infection, reaction to the stitches, a rise in eye pressure due to the steroid drops, thinning of the sclera in eyes treated with mitomycin, and double vision if the eye muscle is affected.

Alternatives and comparison

Surgery is the treatment that removes a pterygium permanently; drops and laser do not destroy the tissue.

Option	Who it is for	Recurrence risk	Note
Monitoring, artificial tears, sun protection	Small, quiet pterygium; pinguecula	—	A short course of drops during red episodes
Bare sclera (removal without a graft)	Not recommended today	High	Removal alone
Conjunctival autograft (with stitches)	Standard method	Low	Stitches are removed in 1–2 weeks
Conjunctival autograft (with tissue glue)	Standard method	Low	The gritty feeling lasts a shorter time
Amniotic membrane graft	Large or recurrent cases, insufficient conjunctiva	Moderate	Can also be used together with an autograft
Mitomycin C (additional measure)	Recurrent cases	Lowers it	In selected patients, because of the risk of scleral thinning

Because a pterygium affects the corneal surface, it is assessed together with corneal diseases; accompanying dry eye and blepharitis are treated before surgery.

This treatment in Kahramanmaraş

Pterygium surgery (pterygium excision with conjunctival autograft) is performed by Dr. Nejmi Öztürk at HG Hospital in Kahramanmaraş, Türkiye. The examination, corneal topography and surgical planning are done at the same hospital; the operation is carried out under local anaesthesia as a day procedure.

HG Hospital is a private hospital contracted with the Turkish social security institution (SGK); patients with valid SGK coverage may use it, although a private-hospital co-payment may apply. Pterygium surgery is generally covered by SGK; removal of a pinguecula purely for appearance may fall outside coverage. Patients without SGK coverage, such as international patients and visitors from abroad, pay privately or through their private or travel health insurance; the hospital checks coverage before treatment. Fee information is given by the hospital after the examination, and insurance coverage is clarified at the consultation.

Patients from Elbistan, Afşin, Göksun, Ekinözü and Nurhak come to HG Hospital in Kahramanmaraş for the examination and surgery; Dr. Öztürk does not see patients in Elbistan. For travel planning, see the patients from Elbistan and the surrounding area page.

Frequently asked questions

Sources

• Turkish Ophthalmological Society — todnet.org
• American Academy of Ophthalmology (AAO) — aao.org
• European Society of Cataract and Refractive Surgeons (ESCRS) — escrs.org
• National Eye Institute (NEI) — nei.nih.gov

Related pages

• Corneal diseases
• Dry eye
• Blepharitis (inflammation of the eyelid margin)
• All eye treatments

This page is for information only; diagnosis and treatment decisions are made after an examination. The results of any surgical or interventional procedure may vary from person to person. You are advised to obtain detailed advice from your physician before any procedure.