Pterygium (Surfer's Eye)
What is pterygium?
Pterygium (pronounced tur-IJ-ee-um) is a raised, fleshy growth on your eye’s conjunctiva. Your conjunctiva is the clear membrane that covers the white of your eye. The conjunctiva normally ends at the clear part of your eye, the cornea. It also lines the inside of your eyelids.
Pterygium comes from the Greek words pteryx, which means “wing,” and pterygion, which means “fin.” Pterygium is a wing-like or triangular-shaped thickening of an area of conjunctiva tissue. It grows from either corner of your eye, but usually more often from the corner closest to your nose. It spreads outward, sometimes onto the cornea of your eye.
Pterygium can affect one or both of your eyes but usually not at the same time. When it affects both eyes at the same time, it’s called bilateral pterygium.
Why is pterygium called surfer’s eye?
The nickname “surfer’s eye” comes from the idea that surfers work in the same elements that cause pterygium — sun, wind and dusty conditions.
Is pterygium a serious condition?
Pterygium is not cancer. However, it can grow large enough to cover part of your cornea (the clear dome that covers your pupil and iris). When this happens, it can affect your vision. In rare cases, pterygium can scar your cornea. Without treatment, you may lose vision.
How long does pterygium last?
Pterygium can grow and spread slowly throughout your life or it may stop at some point.
What is the difference between pterygium and pinguecula?
Both are growths on your eye’s conjunctiva.
Pingueculum is a raised yellowish or white growth on the white of your eye. It stays on the conjunctiva and doesn’t overlap onto your cornea. It usually doesn’t cause symptoms or needs to be removed.
Pterygium is a fleshy growth that has many blood vessels in it. It may remain small or can grow and spread onto the cornea. It may start as a pingueculum.
Who gets pterygium?
Pterygium can happen to anyone who spends a lot of time outdoors in the sun without eye protection. It’s more commonly seen in older adults (over 80 years of age) who live near the equator. Children rarely get pterygium.
About 12% of people in the world develop pterygium.
Symptoms and Causes
What are the signs and symptoms of pterygium?
Sometimes you’ll have no symptoms before pterygium appears. When symptoms do develop, they range from mild to severe.
Early signs and symptoms include:
- A slightly raised pink growth on your eye.
- Red, irritated or swollen eyes.
- Dry eyes, itchy eyes or burning eyes.
- Feeling like you have sand or grit is in your eye.
- Teary eyes.
Late signs and symptoms include:
- Increase in the size and spread of the lesion.
- An unpleasant appearance of your eye due to the size of the lesion.
- Blurred vision or double vision (if pterygium grows onto your cornea).
What causes pterygium?
Pterygium is an overgrowth of your conjunctiva tissue. It’s thought to be caused by:
- Long-term exposure to the sun’s ultraviolet (UV) light (most common cause).
- Eye irritation from hot and dry weather, wind and dust.
Diagnosis and Tests
How is pterygium diagnosed?
Your eye care provider can diagnose pterygium with a slit lamp. A slip lamp is a type of microscope that focuses a narrow (a “slit”) line of bright light on your eye. It helps your provider look at the front and inside of your eye. A slit lamp exam is a normal part of an eye exam.
Other eye tests your provider may perform include:
- Visual acuity test: This test checks how well you can see letters or symbols on a chart 20 feet away.
- Corneal topography: This is a type of photography that uses a computer to create a 3D map of the surface of your cornea.
Your provider may also take pictures of your eye to track changes in the growth of pterygium over time. Your eye care provider may order other tests to rule out other conditions, including cancers that affect the eye.
Management and Treatment
How is pterygium treated?
If your symptoms don’t cause discomfort or interfere with your vision, you probably don’t need treatment. Your provider will schedule office visits to see if the pterygium is growing or causing vision problems.
Your eye care provider may:
- Recommend over-the-counter eye ointments or lubricating (wetting) drops / artificial tears or decongestant drops if your eye is uncomfortable.
- Prescribe steroid eye drops or eye ointments to reduce pain, redness, itching and swelling.
When might surgery be needed?
You may need surgery if:
- Eye drops and eye ointments aren’t relieving your symptoms.
- The pterygium grows so large that it blocks your vision or pulls on your cornea and changes its curve, causing astigmatism. Astigmatism can blur your vision.
- The way your eye looks is not acceptable to you.
What’s involved in pterygium surgery?
There are several surgical strategies. They include:
- Removing only the pterygium.
- Removing the pterygium and placing a sheet of “amniotic membrane” over the affected area, which acts as a bandage to help the eye heal.
- Removing the pterygium and covering the affected area with a healthy piece of conjunctiva (autograft surgery). The healthy conjunctiva is usually taken from behind the upper eyelid. This procedure is best for preventing the return of pterygium, but it’s a longer and more technical surgery.
- Your provider may give you medications at the time of surgery to prevent the pterygium from growing back. These can be used with any of the other surgery types. These medications include mitomycin C and 5-fluorouracil.
Your eye care provider will numb your eye with local anesthesia. You’ll be given light sedation. The pterygium is carefully removed from your eye.
If you’re having surgery with an amniotic membrane, the membrane is cut to the proper size and placed to cover the area where the pterygium was removed. A special glue or stitches hold the amniotic membrane in place.
If you’re having an autograft surgery, your surgeon removes a section of conjunctiva from under your eyelid to cover the opening. A special glue or stitches hold the new tissue in place while it heals.
Surgery typically lasts between 30 minutes and one hour.
What can I expect during recovery after surgery?
You’ll likely wear an eye patch over your eye for a couple of days.
You’ll apply steroid eye drops to the affected eye for a few weeks or months. These eye drops help reduce inflammation and the chance of the growth returning.
You can return to your normal daily activities in a few days.
You and your provider will watch for pterygium recurrence. This is most likely to happen in the first 12 months after surgery.
What are the risk and complications of surgery?
Risks and complications of surgery include:
- Return of pterygium after it’s been removed. To avoid the pterygium growing back, you should take the prescribed steroid drops and avoid sun exposure to the eye.
- Developing a cyst or infection.
- Ongoing double vision that requires surgery.
- Your eye may continue to feel dry or irritated.
- Sclera or corneal melting. This is severe damage to these two layers of your eye. It’s a well-known complication of using mitomycin C and 5-fluorouracil, but it can be treated.
What can I do to lower my risk of a pterygium?
You can lower your risk of developing pterygium, slow its growth if you have one, or help prevent its return after surgery if you:
- Wear sunglasses or a wide-brimmed hat when you’re in the sun to protect your eyes from ultraviolet light. Sunglasses should stop 99% to 100% of both ultraviolet A and ultraviolet B rays. Wrap-around styles are the best. Wear them even on cloudy days.
- Use artificial tears to keep your eyes moist, especially if you live in a dry climate.
Outlook / Prognosis
What outcome can I expect if I have pterygium?
Most individuals who have a pterygium don’t need treatment. Medications can treat symptoms if you have them. If the pterygium blocks or blurs your vision, it can be removed.
If you have surgery, the chance of pterygium returning depends on the type of surgery you had and the amount of sun exposure after surgery.
Pterygium return rates are:
- Up to about 80% if your surgery was only a simple removal technique.
- About 20% if amniotic membrane is used to cover the pterygium site
Between 5% and 10% if your surgery was pterygium removal followed by tissue replacement with a conjunctival flap or autograft.
When should I call my doctor?
Call your provider if you notice any change in your vision or if uncomfortable symptoms return.
You and your eye care provider will schedule regular visits to check your vision and to track the growth of the pterygium.
Frequently Asked Questions
Can I wear contacts if I have pterygium?
If pterygium causes eye discomfort, you probably shouldn’t wear your contact lenses. Ask your eye care provider.
Can pterygium cause blindness?
Pterygium can block or blur your vision if it continues to grow across your cornea. Sometimes pterygium can scar your cornea, but this is rare. The scarring can be treated if it’s minor. If the scarring is major, damage to your corneal can cause blindness. It’s technically possible but rare that pterygium would result in blindness. Cases are usually minor or treated with medication or surgery if needed.
Does pterygium go away on its own?
It won’t go away on its own. A small pterygium may never cause problems for the eye as long as it stops growing. In most cases, the only way to completely remove a pterygium is with surgery.
What’s the difference between pterygium and a cataract?
Pterygium is an overgrowth of the conjunctiva tissue itself. It results in a raised area on your conjunctiva — the clear membrane that covers the entire front of your eye.
A cataract is a clouding of the lens of your eye. Your lens is behind your iris (colored part of your eye). Your lens focuses light and works with your brain to process information and create a picture of what you see.
A note from Cleveland Clinic
Although pterygium looks odd and even scary, it’s not a serious eye condition. You may not even need treatment. If it’s causing symptoms, call your eye care provider. Artificial tears and steroid ointment or eye drops can relieve your eye discomfort. If the pterygium spreads and interferes with your vision or if you’re uncomfortable with the way your eye looks, your eye care provider can help. They will talk with you about surgical options as well as risks, complications and outcomes. To protect your eyes, remember to wear sunglasses with UV ray protection when you’re outside, even on cloudy days.
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