Pinguecula and Pterygium

Definition

Pinguecula and pterygium are both non-malignant, slow-growing proliferations of conjunctival connective tissue in the eye. Pterygia, but not pingueculae, extend over the cornea.

Description

The outer layer of the eyeball consists of the tough white sclera and the transparent cornea. The cornea lies in front of the colored part of the eye (iris). Overlying the sclera is a transparent mucous membrane called the conjunctiva. The conjunctiva lines the inside of the lids (palpebral conjunctiva) and covers the sclera (bulbar conjunctiva).

Pingueculae and pterygia are common in adults, and their incidence increases with age. Pterygia are less common than pingueculae.

Pingueculae are seen as small, raised, thickenings of the conjunctiva. They may be yellow, gray, white, or colorless. They are almost always to one side of the iris—not above or below—and usually on the side closest to the nose. A pinguecula may develop into a pterygium.

Pterygia are conjunctival thickenings that may have blood vessels associated with them. They often have a triangular-shaped appearance. The pterygia may also grow over the cornea and may therefore affect vision.

Causes and symptoms

Causes

The cause or causes of these disorders are unknown, but they are more frequent in people who live in sunny and windy climates and people whose jobs expose them to ultraviolet (UV) light (for example, farmers and arc welders). Pingueculae and pterygia also occur in older people. It is thought these growths are the result of UV or infrared light and irritation. It is also believed that prolonged exposure to these risk factors (that is, UV light) increases the chances of occurrence.

Symptoms

Although some people with pinguecula constantly feel like they have a foreign body in their eye, most are asymptomatic. Because the lids can no longer spread the tears over a smooth area, dry areas may result. Some people with a pterygium are also asymptomatic; some feel like they have a foreign body in their eye. Because a pterygium can stretch and distort the cornea, some people acquire astigmatism from a pterygium.

Diagnosis

An eye doctor (ophthalmologist or optometrist) can usually diagnose pingueculae and pterygia by external observation, generally using an instrument called a slit lamp. A slit lamp is a microscope with a light source and magnifies the structures of the eye for the examiner. However, because pingueculae and pterygia can sometimes look similar to more serious eye growths, it is important for people to have them checked by an eye care professional.

Treatment

Usually, no treatment is needed. Artificial tears can be used to relieve the sensation of a foreign body in the eye and to protect against dryness. Surgery to remove the pinguecula or pterygium is advisable when the effect on the cornea causes visual defects or when the thickening is causing excessive and recurrent discomfort or inflammation. Sometimes surgical removal is also performed for cosmetic reasons. However, healing from this type of surgery, although usually painless, takes many weeks, and there is a high rate of recurrence (as high as 50-60% in some regions). Accordingly, surgery is avoided unless problems due to the pinguecula or pterygium are significant.

Several methods have been used to attempt to reduce the recurrence of the pinguecula or pterygium after surgery. One method that should be abandoned is beta radiation. Although it is effective at slowing the regrowth of pingueculae and pterygia, it can cause cataracts. A preferable method is the topical application of the anticancer drug, mitomycin-C.

Prognosis

Most pingueculae and pterygia grow slowly and almost never cause significant damage, so the prognosis is excellent. Again, a diagnosis must be made to rule out other more serious disorders.

KEY TERMS

Astigmatism— Asymetric vision problems due to irregularities in the cornea.

Beta radiation— Streams of electrons emitted by beta emitters like carbon-14 and radium.

Conjuctiva— The mucous membrane that covers the white part of the eyes and lines the eyelids.

Cornea— The clear outer covering of the front of the eye. It is in front of the colored part of the eye (iris) and the iris's central black hole (pupil).

Prevention

There is nothing that has been clearly shown to prevent these disorders, or to prevent a pinguecula from progressing to a pterygium. However, the presence of pingueculae and pterygia have been linked to exposure to UV radiation. For that reason, UV exposure should be reduced. The American Optometric Association (AOA) suggests that sunglasses should block 99-100% of UV-A and UV-B rays. Patients should speak to their eye care professionals about protective coatings on sunglasses or regular spectacles. Protecting the eyes from sunlight, dust, and other environmental irritants is a good idea.

Resources

ORGANIZATIONS

New York University (NYU), Department of Ophthalmology. 550 First Ave., New York, NY 10016. (212) 263-6433. 〈http://ophth-www.med.nyu.edu/Ophth〉.