Pterygium (surfer's eye): causes, symptoms and treatments

What are Pterygium Symptoms?

In its early stages, a pterygium is usually asymptomatic. However, when inflamed, it can cause itching, a foreign body (gritty) sensation, tearing, and burning. In its later stages, a pterygium can grow over your iris and pupil, blurring your vision. 

The cause of a pterygium is unclear, but it is found more often in populations living close to the equator who have prolonged exposure to sun and UV rays. Pterygia are most common in men who work in outdoor settings. That is why this condition is sometimes called Surfer’s Eye because of its common occurrence among surfers.

What causes pterygium?

Theories abound for possible pterygium causes, including radiation activation of special growth cells called fibroblasts, choline deficiency, an inflammatory disorder, a vascular disorder causing uncontrolled blood vessel growth, immune system abnormalities, tear film abnormalities, and even a possible viral link. 

The exact cause of pterygium remains unknown. Because it is referred to as a tumor, some people may fear that it is a form of cancer. Rest assured, pterygium is a benign (non-cancerous) lesion that does not spread beyond the surface of the eye.

How is pterygium diagnosed?

By simple observation. Your eye doctor makes a formal diagnosis following a slit-lamp examination that allows close-up observation of the lesion under magnification. A biopsy is often taken at the time of removal and sent to a pathologist for diagnostic confirmation. 

A thorough eye exam should be performed if you have an apparent pterygium to assess its impact on your vision and to rule out less common diagnoses that can cause an eye tumor.

At AGEI your eye exam will include:

• An assessment of your visual acuity and peripheral vision (known as visual fields)
• External examination of your eyelids, eyelashes, and tear ducts (lacrimal glands)
• Examination of the conjunctiva (the pink tissue lining your eyelids and the inner corner of your eye)
• Slit-lamp examination of the surface and front internal structures of your eye (anterior segment)
• Measurement of the curvature of your cornea (keratometry)
• Examination of the ocular surface (corneal topography)
• Examination of your pupils and posterior eye structures (fundoscopic exam)
• Measurement of your intraocular pressure

Your doctor will also measure how far the pterygium extends over your cornea and usually will have you return for follow-up exams every 1 to 2 years to determine the rate of its growth toward your visual axis.

Pterygium causes and risk factors

Risk Factors for pterygium include:

• Exposure to ultraviolet light (from the sun or other sources)
• Residing in sunny climates close to the equator
• Being in dry, dusty climates
• Having an outdoor lifestyle (working outdoors increases your risk by 150%)

Pterygium (surfer's eye) treatment

Treatment of a pterygium is initially limited to watching it over time to see if it expands over your visual axis. Symptoms of irritation, foreign body sensation, and tearing can be alleviated with over-the-counter anti-allergy drops, lubricating eye drops, artificial tears, anti-inflammatory agents, and ointments.

Because spending a lot of time in the sun is associated with a high risk of pterygium, it’s important to wear UVA/UVB-blocking sunglasses when outdoors.

Due to the potential for recurrence of a more aggressive pterygium lesion, as well as other surgical risks associated with some older surgical techniques, the surgical removal of pterygia should not be undertaken casually.

Surgical removal of the pterygium using ultramodern approaches can reduce the recurrence rates by more than 20-fold.

Does pterygium return after surgery?

Unfortunately, pterygium surgery is not as simple as cutting the growth out of your conjunctiva and sewing the borders of the remaining gap closed because this approach is associated with an 80 percent chance of the pterygium growing back. In fact, 97 percent of regrowth occurs in the first year following the surgical removal of a pterygium.

Because of the high recurrence rate associated with simple extraction of pterygia, ophthalmologists will sometimes take some of the patient's own conjunctiva from another part of the eye and use it as a graft to fill in the gap left when the pterygium was removed.

This approach, known as conjunctival autografting, continues to be used to this day with some success but can still have recurrence rates of up to 33 percent. Better odds, but still not great by any means.

How does AGEI cut pterygium recurrence from 80% to below 1%?

At AGEI, we perform a much more refined approach to surgical removal of pterygia using a technique which, we have found, reduces the rate of recurrence from the historical 80 percent to less than 1 percent.

We start by carefully lifting off the pterygium mass and removing the underlying scar tissue from your conjunctiva. Next, we allow the healthy conjunctival tissue that was displaced by the pterygium to retract to its original location. We then fill in the hole left by the pterygium removal with processed amniotic membrane taken from human placental tissue.

The amniotic membrane is similar in composition to conjunctival tissue, which makes it a highly compatible graft material for eye surgery. Because it has properties that inhibit inflammation, scarring, and the formation of new blood vessels, the amniotic membrane has wide application in all types of graft surgeries. And it is a safe graft material: there are no published reports of human disease transmission resulting from an amniotic membrane graft to the eye.

The amniotic graft is secured in place using a special adhesive (called fibrin glue) which offers the advantage of avoiding the post-op discomfort and inflammation caused by sutures. By minimizing post-op inflammation at the graft site, the fibrin glue also helps reduce the chance of the pterygium growing back.

We take an extra step in order to further reduce the chance of pterygium recurrence due to inflammation. Once we remove the pterygium and before we insert the amniotic graft, we apply two strong medications (Mitomycin C and prednisolone) to suppress scarring and inflammation into the tissue defect.

Following surgery, your doctor will prescribe antibiotics and steroid eye drops that must be applied daily for several weeks in order to achieve optimal results. We have been using the above protocol for over 12 years, and currently, our primary pterygium recurrence rates are below 1%.

Should I undergo pterygium removal surgery?

With the dramatic improvement in results over the years at our center, most patients now undergo removal at earlier stages for cosmetic reasons rather than due to any visual loss.

Still, the decision to undergo pterygium removal surgery should be done after careful consideration and discussion with your eye doctor and primary health care provider to ensure that you understand the risks and benefits of the procedure and are willing to perform the post-operative eye care regimen necessary for successful results.

Pterygium FAQs

Can surfer’s eye go away?

Surfer's eye can go away with treatment or surgery, but preventive measures are crucial to avoid recurrence. 

How to prevent surfer’s eye (pterygium)?

To prevent surfer's eye you can take the following steps:

• wear sunglasses that block 100% of UV rays to protect your eyes from the harmful effects of the sun. Look for sunglasses with polarized lenses that reduce glare and provide better vision on the water.
• wear a wide-brimmed hat to shade your face and eyes from the sun's rays.
• use artificial tears to keep your eyes moist and prevent dryness, which can lead to irritation.
• take regular breaks from being in the sun, wind, and dust to give your eyes a rest.
• rubbing your eyes can irritate them and increase the risk of developing surfer's eye.
• smoking can increase the risk of developing surfer's eye and other eye diseases.

Is pterygium dangerous?

Surfer's eye is not usually dangerous, but it can cause discomfort and affect vision if it grows large enough to cover the cornea. In some cases, it can also lead to astigmatism or distortion of the cornea, which can affect the clarity of vision.

Why is it called surfer’s eye?

Surfer's eye, also known as pterygium, is called that because it is often seen in people who spend much time in the sun and wind, such as surfers. The condition is most commonly seen in people who live in tropical or subtropical climates with high UV radiation exposure.

AGEI, Los Angeles' top ophthalmology team

Our nationally recognized ophthalmologists are expertly trained in LASIK, retinal, pterygium, and cataract surgery. They offer state-of-the-art treatments for all eye conditions, including glaucoma, macular disease, and diabetic eye conditions, to name just a few.

We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Los Angeles, Beverly Hills, Santa Monica, and Culver City.