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

What are Pterygium Symptoms?

Pterygium is usually asymptomatic in its early stages. However, when inflamed, it can cause eye irritation: itching, tearing, and burning. As the pterygium advances, it can grow over your iris and pupil, causing blurred vision. A pterygium can also cause contact lens intolerance.

Pterygium causes and risk factors

The exact cause of 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. This condition is sometimes called Surfer’s Eye because of its common occurrence among surfers.

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
• Spending a lot of time outdoors (working outdoors increases your risk by 150%)
• Complications from dry eye disease

How is pterygium diagnosed?

By simple observation. We can make 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 a pterygium to assess its impact on your vision and to rule out less common diagnoses that can cause an eye tumor.

Our eye specialist 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 treatment

Treatment may not be required if your symptoms aren’t causing discomfort or interfering with your vision.

Our eye care provider may:

• Recommend over-the-counter anti-allergy drops, lubricating eye drops, artificial tears, anti-inflammatory agents, and ointments.
• Prescribe steroid drops or ointments to reduce pain, redness, itching, and swelling.
• Recommend wearing UVA/UVB-blocking sunglasses when outdoors.

Pterygium surgery (pterygium excision)

If conservative treatments aren’t successful in relieving symptoms, or the appearance of pterygia makes you self-conscious, surgery may be needed.

Unfortunately, pterygium surgery is not as simple as cutting the growth out of your conjunctiva 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, our ophthalmologists will sometimes take some of the patient's 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 autograft, continues to be used with success but can still have recurrence rates of up to 33 percent. They have better odds, but still not great by any means.

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

Over the past 12 years, AGEI's surgeons have adopted many advancements in the field which have led to a pterygium recurrence rate at our practice below 1 percent. These surgical techniques include:

• Carefully removing the pterygium and underlying scar tissue to achieve clean borders
• Minimizing the surgical manipulation of the tissue surrounding the gap
• Using amniotic membrane graft for its ability to suppress post-op inflammation, scarring and new blood vessel formation
• Bathing the gap created by the pterygium removal with two powerful medications to minimize post-op inflammation and scarring that lead to increased risk of recurrence
• Affixing the graft with fibrin glue to decrease inflammation and irritation at the graft site caused by sutures and to act as a physical barrier along the perimeter of the graft site to thwart pterygium re-growth
• Following a meticulous post-op medication regimen designed to suppress swelling and infection

What to expect after eye whitening surgery

After surgery, your doctor will prescribe steroid and antibiotic eye drops to minimize the chances of recurrence and to prevent infection. Compliance with the dosing schedule is key to helping prevent recurrent pterygium.

Your doctor will check you on the day following surgery. Then you will follow up at one week, one month, three months, six months, and one year post-op. After that, you will be seen annually to check for pterygium recurrence.

You may feel irritation and a foreign body sensation in your eye once your anesthesia wears off. These symptoms will resolve in a week. There will also be redness at the surgical site that can last up to six weeks.

Typically, patients will take from six to eight weeks to heal fully. Smaller pterygia will heal faster than larger ones.

Should I undergo pterygium removal eye 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 made 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.

Assil Gaur Eye Institute, Los Angeles' top ophthalmology team for pterygium care

Our nationally recognized ophthalmologists and corneal specialists are leaders in a wide range of ophthalmological conditions, including state-of-the-art LASIK vision correction, retinal treatments, cataract surgery, glaucoma care, 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, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.

Sources

Alsagoff Z, Tan DTH, Chee S. Necrotising scleritis after bare sclera excision of pterygium. Br J Ophthalmol. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1723636/) 2000;84:1050

Academy of Ophthalmology. EyeSmart. What is a Pinguecula and a Pterygium (Surfer’s Eye)? (https://www.aao.org/eye-health/diseases/pinguecula-pterygium) Accessed 2/22/2022

Consumer Version. Pinguecula and Pterygium. (https://www.merckmanuals.com/home/eye-disorders/conjunctival-and-scleral-disorders/pinguecula-and-pterygium?query=pterygium) Accessed 2/22/2022