Harvard Eye Associates specializes in Pterygium Surgery Pterygia Eye Growth Terygium Terygia San Clemente Laguna Hills Aliso Viejo Irvine Newport Beach Orange County.
(terygium, terygia) In most cases, routine ocular evaluation reveals Pterygium (terygium, terygia). Vascularized pterygium may become red and inflamed. The pterygium may induce irregular corneal warpage. Ultraviolet light exposure appears to be the most significant factor in the development of pterygia. Agents that may contribute to the formation of pterygia include allergens, noxious chemicals and irritants. Whatever the etiology, pterygia represent a degeneration of the conjunctival stroma with replacement by thickened, tortuous elastotic fibers. Activated fibroblasts in the leading edge of the pterygium invade and fragment Bowman's layer as well as a variable amount of the superficial corneal stroma. Pterygium development resembles actinic degeneration of the skin. Because pterygia appear to be linked to environmental exposure, manage asymptomatic or mildly irritative cases with UV-blocking spectacles and liberal ocular lubrication. Irritated pterygia with topical decongestant/antihistamine combinations (terygium, terygia)
Causes of Pterygium
Traditional "bare sclera" pterygium surgery has a high rate of re-growth. Occasionally, the pterygium grows back larger than the original.
UV radiation (usually from sunlight) is the most common cause of pterygium. This explains why pterygium occurs with increasing frequency in climates approaching the equator. Other causes include continuous exposure to dry, dusty environments. People who spend significant time in water sports are particularly susceptible to pterygium because of the intense exposure to UV that occurs in these environments. Preventing Pterygium
The best method of preventing pterygium is to regularly wear UV 400 rated sunglasses when outdoors in sunny conditions. Treating Pterygium
In mild cases, pterygium redness and discomfort can be controlled with lubricant eye drops. When vision is affected by progressive growth of a pterygium, surgery is considered.
History of Pterygium Surgery
In pterygium surgery, the abnormal tissue is removed from the cornea and sclera. Over the years, pterygium surgery has evolved significantly, and modern pterygium surgery has a significantly higher success rate than conventional surgery. In traditional "bare sclera" pterygium removal, the underlying white of the eye (sclera) is left exposed. Unfortunately, the pterygium may grow back in up to 50% of patients. In many cases, the pterygium grows back larger than its original size.
Over the years, surgeons have used several different techniques to lessen the likelihood of pterygium recurrence.
Most cornea specialists today perform pterygium surgery with a conjunctival autograft because of a reduced risk of recurrence. In this technique, the pterygium is removed, and the cornea regains clarity. However, the gap in the mucous membrane tissue, where the pterygium was removed, is filled with a transplant of tissue that has been painlessly removed from underneath the upper eyelid. Although the procedure requires more surgical skill than traditional surgery, this "auto-graft" (self-transplant) helps prevent re-growth of the pterygium by filling the space where abnormal tissue would have re-grown.
Stitches on the eye frequently cause discomfort, however, after pterygium/autograft surgery. The desire for a quicker, more painless recovery has led to the development of no-stitch pterygium/autograft surgery. No-stitch Pterygium/Autograft Surgery No-stitch pterygium/autograft surgery allows most patients to return to work
within one or two days of surgery. A research study on 85 patients with pterygium conducted at Harvard Eye Associates has shown that patients undergoing no-stitch surgery had significantly less pain after surgery than those having traditional surgery. The no-stitch technique also reduced surgery time from an average of 21 minutes to 14 minutes. No pterygium recurrences were found in any patients in the study.
Technique for No-stitch Pterygium/Autograft Surgery
For more information on no-stitch pterygium surgery and Harvard Eye Associates, please contact us. Pterygium (terygium, terygia) eye growth: Surgical excision of pterygia is indicated only for unacceptable cosmesis and/or significant encroachment of the visual axis. The treatment of choice involves dissection and removal of the fibrous tissue down to the level of Tenon's capsule. Free conjunctival flaps are then grafted over the bare sclera. Postoperative adjuvant therapy with b-radiation, topical thiotepa, mitomycin-C and other antimetabolic agents may diminish the chance of recurrence. In cases that involve significant corneal scarring, lamellar or penetrating keratoplasty may be indicated. A pterygium is a benign clinical entity in most cases. Distinguish between the potentially progressive pterygium and the less threatening pinguecula-large pingueculae may be difficult to differentiate from pterygia. Conjunctival intraepithelial neoplasia (CIN), a precursor of conjunctival squamous cell carcinoma, is another clinical entity that must be ruled out in the diagnosis of pterygia. This lesion is generally unilateral, elevated and gelatinous, with deep irregular vascularization and an ameboid shape. CIN is an invasive ocular cancer that can inflict significant morbidity. Obtain a biopsy if CIN is suspected. Pterygia can affect vision if left unchecked. The corneal degradation may extend beyond the leading edge of the lesion. This means that the pterygium need not cover the visual axis to inflict significant visual compromise. Surgery must be performed before vision is affected. Follow up on medium- to large-sized pterygia at least once or twice yearly, and include a manifest refraction, corneal topography, slit lamp evaluation with measurement of the pterygium, and photodocumentation if possible. Pterygia often persist after surgical removal; these lesions appear as a fibrovascular scar arising from the excision site. These recurrent pterygia (terygium, terygia) probably have no relationship to ultraviolet radiation, but rather may be likened to keloid development in the skin. Clinical inspection of pterygia reveals a raised, whitish, triangular wedge of fibrovascular tissue, whose base lies within the interpalpebral conjunctiva and whose apex encroaches the cornea. The leading edge of this tissue often displays a fine, reddish-brown iron deposition line (Stocker's line). The vast majority of pterygia (about 90 percent) are located nasally. These lesions are more commonly encountered in warm, dry climates, or in patients who are chronically exposed to outdoor elements or smoky/dusty environments. Pterygia must be distinguished from pingueculae, which are more yellow in color and lie within the interpalpebral space but generally do not encroach beyond the limbus. Pingueculae also lack the wing-shaped appearance of pterygia, the former being more oval or ameboid in appearance (terygium, terygia): San Clemente Laguna Hills Aliso Viejo Irvine Newport Beach Orange County Mission Viejo Dana Point San Juan Capistrano Laguna Beach Lake Forest Capistrano Beach Laguna Niguel Rancho Santa Margarita Trabuco Canyon Laguna Woods FootHill Ranch Costa Mesa Ladera Ranch Corona Del Mar Huntington Beach Orange County California PTERYGIUM AND PINGUECULA What is a pterygium? Figure 1: Pterygium on the cornea. A pterygium is fleshy tissue that grows in a triangular shape over the cornea (the transparent part or front window of the eyeball). It may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner corner of the eye, with its apex towards the pupil, but also may appear on the outer corner. What causes pterygium? The exact cause is not well understood. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry; dusty conditions seem to play an important role. Hence Pterygium occurs more often in people who spend a great deal of time outdoors, especially in sunny climates. A dry eye may contribute to pterygium as well. How is pterygium treated? When a pterygium becomes red and irritated, eye drops or ointments, which can be spread in the eye, may be used to smooth the inflammation. Large enough pterygia that threatens sight, grows or is unsightly, can be removed surgically. It may occur that despite proper surgical removal the pterygium returns. That affects particularly young people. To help prevent recurrences surface radiation or medications are sometimes used. Wearing UV protective sunglasses and avoiding dry and dusty conditions as well as the use of artificial tears may also help. PTERYGIUM AND PINGUECULA What is a pinguecula? Pinguecula next to cornea. A pinguecula is a small yellow growth on the white of the eye near the edge of the cornea, usually on the nasal (nose) side. However, a pinguecula does not actually grow onto the cornea such as a pterygium, and it is not a tumour. It is an alteration of normal tissue resulting in a deposit of protein and fat. It is a condition affecting particularly older people. A pinguecula may also be caused by chronic eye irritation or sunlight. How is pinguecula treated? As a pinguecula does not grow onto the cornea nor threaten sight, no treatment is necessary unless it becomes inflamed. On very rare occasions a pinguecula may be surgically removed for cosmetic reasons or if particularly annoying. However, the post-operation scar may be as cosmetically objectionable as the pinguecula. Why should you have regular eye examination? Regular medical eye examinations are important for everyone, as eye disease can occur at any age. Often the patient does not realise symptoms unless the disease has done damage. Therefore, if diagnosed and treated early, most blindness is preventable.