Pterygium: Causes, Symptoms, Treatment and Cost

A Pterygium is a benign growth which usually appears as a fleshy, triangular tissue on the white part of the eye (sclera). It can also appear on both eyes and may even extend to the cornea. It is an inflammatory disorder which can cause redness and itching of the eye, blurred vision, and a feeling of sand-like particles in the eye.

There are three types of pterygium:

• Primary Pterygium: This type of pterygium is usually the result of long-term exposure to sunlight or winds that carry dust or sand particles onto the eye. It most commonly starts near the nasal corner and may grow towards the centre of the cornea over time.
• Secondary Pterygium: This type develops from scarring caused by injury or infection on the eye’s surface. Unlike primary pterygia, it can occur on any part of the cornea—even in rare instances where multiple secondary pterygium are present at once.
• Acquired Pterygium: This type is caused by an underlying disease or condition that affects ocular surface health such as glaucoma, diabetes, herpes simplex virus (HSV), autoimmune disease, dry eyes or chemical burns to the eye area. It may also occur as a result of long-term use of certain medications such as corticosteroids.

Pterygium is most commonly caused by prolonged exposure to ultraviolet rays from the sun and other environmental factors such as dust, wind, dryness.

Other possible causes include genetics, underlying eye diseases or a lack of vitamin A in the diet.

• Redness of the eye
• Itchiness
• Swelling and tenderness of the conjunctiva.
• A growth on the whites of the eye which has a white, pink, or flesh colour.
• Insecurity to light; pain and symptoms similar to having sand in the eye.
• Squinting or closing one's eyes in bright light.
• Blurry vision due to distorted cornea.

• Wear sunglasses when outdoors.
• Limit time spent in direct sunlight.
• Cover eyes with a wide-brimmed hat.
• Use sunscreen with UVA and UVB protection.
• Avoid contact lenses or use properly maintained lenses every day.

• Physical examination: The physical examination of pterygium typically includes the observation of any visible change or abnormality in the eye. To confirm the diagnosis, a healthcare provider will generally assess the size, shape and colour of the pterygium, as well as any other areas surrounding it.
• Slit Lamp Biomicroscopy: Slit lamp biomicroscopy is a valuable tool for diagnosing pterygium, as it allows detailed imaging and inspection of the area in question. During slit lamp biomicroscopy, ophthalmologists can use specialised lenses to magnify and examine the tissue around the pterygium.
• Ocular Ultrasound: An ocular ultrasound can be used to check for pterygiums as they appear as a thickening of the conjunctiva and an increase in depth. The ultrasound can also be used to gauge the size and location of the pterygium, which is important for determining the best treatment option.
• Corneal topography: Corneal topography is an imaging technique that maps the curvature of the surface of the eye, providing detailed information about its shape and any irregularities present. This helps the doctor identify changes in the shape of the cornea which could be related to abnormal conditions such as a pterygium.

• In some cases, pterygium may cause vision problems, such as astigmatism and distortion of vision.
• It may also worsen over time, requiring surgical intervention or increasing the risk of developing glaucoma, cataracts, or other eye conditions.
• Pterygium can also cause discomfort and the feeling of dryness in the affected eye.
• People with pterygia may experience sensitivity to light or difficulty wearing contact lenses.
• In rare cases, recurrent pterygium can lead to total corneal obscuration resulting in blindness in the affected eye.

• Gently massage sesame oil on the affected area three times a day.
• Apply a mixture of turmeric, honey and castor oil on the pterygium every night before going to bed.
• Dip a washcloth in warm water, wring out the excess water and press it against the affected area for a few minutes.
• Boil water with neem leaves and use this solution to rinse your eyes four times daily.
• Crush two garlic cloves and add a few drops of honey to it, then apply this paste onto the pterygium twice daily until symptoms subside.

• Consume a well-balanced diet, including plenty of fresh fruit and vegetables.
• Include a variety of proteins from both plant- and animal-based sources.
• Increase intake of omega-3 fatty acids from fish, nuts, and/or supplements to reduce inflammation related to the disease.

• Avoid spicy, salty, and acidic foods: Foods that are spicy, salty, or acidic can aggravate pterygium and should be avoided.
• Steer clear of processed and high-fat foods: Processed food, such as hotdogs, bacon, and salami contain nitrates that can further damage the lining of your eyes. High-fat foods such as fried or processed meats can also increase eye inflammation.
• Stay away from artificial sweeteners: Artificial sweeteners like aspartame can aggravate pterygium symptoms and should be avoided.
• Limit caffeine intake: Too much caffeine can increase eye inflammation in those with pterygium and should be limited in the diet.

• Medications: Treatment typically involves using medicated ointments or artificial tears to reduce inflammation and dryness. In more severe cases, eye drops with steroid medications may be prescribed.
• Intense pulsed light (IPL) therapy: Intense pulsed light (IPL) therapy is a type of optical treatment used to reduce the appearance of certain skin conditions, such as pterygiums. It involves applying short pulses of a concentrated, high-intensity light onto the affected area. The light helps shrink any enlarged or overgrown tissue, allowing for easier removal of the pterygium
• Cryrotherapy: Cryrotherapy is a type of treatment for a pterygium. It involves the freezing of the pterygium with liquid nitrogen. The freezing process works to destroy the excess tissue that forms over the normally clear part of the eye, providing significant improvement in vision and reducing the risk for permanent scarring on the outer layer of the eye.
• Conjunctival autograft: Taking small amount of healthy conjunctival tissue from the patient's upper eyelid and transplanting it onto the affected area to replace the removed pterygium.
• Amniotic membrane graft: Underlying amniotic membrane is sutured to replace the removed tissue, which serves as a scaffold for reconstruction of new tissue and closure of the defect.

The best doctor to consult for pterygium treatment is an ophthalmologist, a doctor who specializes in eye care and surgeries. An ophthalmologist will examine your eyes and decide on a treatment plan depending on the severity of your condition.

The best medicines used to treat pterygium include:

• Artificial tears: Artificial tears are lubricating drops used to moisten and relieve dry eyes. In addition, they can help reduce inflammation and irritation associated with pterygium.
• Non-steroidal anti-inflammatory drugs: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pterygium. Examples of NSAIDs include ibuprofen, naproxen, indomethacin, and aspirin. These medications can reduce the inflammation associated with pterygium and reduce symptoms such as redness and irritation.
• Topical steroids: Topical steroids are commonly used to reduce inflammation associated with a pterygium. Topical corticosteroids can be applied directly to the eye to reduce inflammation, reduce the size and thickness of the pterygia, and decrease discomfort.
• Miotics: These medications constrict the pupil, which can reduce the size of a pterygium and sometimes shrink it over time. However, long-term use of miotics can cause serious side effects, so they should be used with caution.

Recovery time from a pterygium varies depending on the type of treatment chosen. Generally, it takes 1-2 weeks for the eye to heal after surgery and no further treatment may be needed. Non-surgical treatments such as steroid eyedrops and ointments can take up to 8 weeks for full recovery.

The results of treatment for pterygium are generally considered permanent. The success of the treatment largely depends on the skill of the doctor, the size and severity of the pterygium, patient's age and overall health, and whether scarring or recurrence has occurred in the past.

Generally, if a patient does not have any symptoms after treatment then it can be assumed that the effects are permanent. However, if symptoms come back in a year or two, additional treatment may be necessary to prevent recurrent episodes from happening again.

• Patients who have had pterygium treatment should follow a few simple guidelines in order to support the healing process and reduce their chances of relapse.
• These include regularly using lubricating eye drops or artificial tears to keep the eyes moist and reduce inflammation.
• It is also important to wear sunglasses that offer UV protection when outside, even on cloudy days, since sunlight can increase your risk of recurrence or other eye problems such as cataracts and macular degeneration.
• Avoid any activities such as swimming or dusting that could potentially cause irritation and/or infection in the eye area; also be sure to use appropriate safety eyewear during activities that involve debris flying through the air.
• Finally, follow up with your healthcare provider as recommended in order to monitor healing and ensure no complications arise during recovery process.

The cost of Pterygium treatments in India may vary depending on the diagnosis, complexity of the pterygium and choice of procedure (surgery or other). Generally, basic treatments can vary from Rs 3,000 to Rs 11,000 while advanced methods may cost between Rs 15,000 to Rs 20,000. Any additional tests required prior to treatment insurances are also available at an extra cost.

• Common side effects of pterygium treatment include temporary dry eye, blurry vision and redness.
• Potential risks associated with pterygium surgery include corneal melting, infection and bleeding.
• Scarring and recurrence are two of the most common post-surgical complications related to pterygium surgery.
• In addition to the surgical risks, steroid drops or injections used for treatment can lead to glaucoma or cataract development in some cases.

If you are suffering from any complications relating to pterygium then you should consult a doctor nearby as they can cause complications like 'vision problems, sensitivity to light, blindness' in which treatment course can range from a few months to years depending on the severity of the situation.