Pterygium: Symptoms, Types, Causes and Treatment

Pterygium is a common eye condition, especially in sunny climates, that can cause discomfort and vision problems. This article explores pterygium in depth, including its symptoms, types, causes, and the latest treatment options. If you or someone you know has noticed a fleshy growth on the eye, understanding pterygium is important for eye health and quality of life.

Symptoms of Pterygium

Pterygium doesn’t just affect vision—it can also impact comfort and self-confidence. While many people notice the growth itself, symptoms can vary widely from person to person. Recognizing these symptoms early is crucial for timely intervention and management.

Symptom	Description	Impact	Sources
Redness	Bloodshot appearance, often persistent	Cosmetic, discomfort	2 3 4 5 1
Foreign body sensation	Feeling like something is in the eye	Irritation, blinking	2 3 4 5 1
Tearing	Excessive watering of eyes	Blurred vision, annoyance	2 3 4 5
Burning/Itching	Sensation of heat or itchiness	Discomfort	2 4 5
Blurred vision	Distorted or reduced clarity	Vision impairment	3 4 5 7 1
Photophobia	Sensitivity to light	Avoidance of bright areas	2 4
Astigmatism	Irregular cornea shape	Visual distortion	1 5 7 4
Cosmetic concern	Noticeable eye growth	Self-esteem impact	2 5

Table 1: Key Symptoms

Understanding the Symptoms

Redness and Irritation

Redness is often the most visible sign, caused by increased blood flow and inflammation in the conjunctiva. This can be persistent, making the eye look bloodshot and sometimes leading to embarrassment or concern about appearance 1 2 4.

Sensations: Foreign Body, Burning, and Itching

Most patients describe the sensation that something is constantly in their eye. This foreign body sensation is nearly universal among those with pterygium 5. Burning and itching are also common, driven by inflammation and disruption of the tear film 1 2 4.

Tearing and Dryness

Ironically, while some patients complain of dry eye, others experience excessive tearing. This imbalance arises because the pterygium disrupts normal tear distribution and drainage, leading to either watery or dry sensations 1 3 5.

Blurred Vision and Astigmatism

As the pterygium grows, it can extend onto the cornea, distorting its shape and causing astigmatism. This leads to blurring or distortion of vision, especially if the growth approaches the visual axis 1 4 5 7.

Photophobia and Cosmetic Concerns

Sensitivity to light (photophobia) is less common but can be troubling. Many patients also report feeling self-conscious due to the visible nature of the growth, especially when it becomes more pronounced 2 4 5.

Types of Pterygium

Pterygium isn’t a one-size-fits-all condition. Understanding its types helps guide management and treatment. Classification is based on location, progression, and recurrence.

Type	Defining Feature	Prevalence/Pattern	Sources
Nasal	Grows from nasal side of eye	Most common	8 4
Temporal	Grows from temporal (outer) side	Less common	8
Unilateral	One eye affected	Majority of cases	8
Bilateral	Both eyes affected	Less frequent	3 8
Progressive	Actively growing, vascular	Causes symptoms, vision	8 7
Atrophic	Stationary, less vascular	Fewer symptoms	8
Recurrent	Returns after removal	More aggressive	8 17
Grades (I-III)	Based on corneal involvement	Severity, prognosis	3 8 7

Table 2: Pterygium Types and Patterns

Classification Explained

By Location: Nasal vs Temporal

Most pterygia arise from the nasal conjunctiva (the side closer to the nose), likely due to sun exposure patterns. Temporal pterygia (on the outer side) do occur but less frequently 8 4.

Laterality: Unilateral vs Bilateral

Unilateral pterygium (one eye) is more common, but bilateral cases (both eyes) are seen, especially in populations with high UV exposure 8 3.

By Growth: Progressive vs Atrophic

• Progressive pterygium is thick, fleshy, and vascular, indicating active growth and a higher risk of vision problems 8 7.
• Atrophic pterygium is thin and less vascular—often stable for years and less likely to affect vision 8.

Recurrent Pterygium

Sometimes, the condition returns after treatment, becoming more invasive and challenging to manage 8 17.

Grading

Grading systems often range from I to III, based on how far the growth extends onto the cornea and how much it distorts vision 3 8 7.

Impact on Vision and Oculovisual Function

Different types and grades affect vision in unique ways:

• Advanced/progressive types are much more likely to cause significant visual problems and should be prioritized for treatment 7.
• Early or atrophic types may be monitored unless they cause discomfort or cosmetic issues.

Causes of Pterygium

Pterygium is more than just a benign growth—it’s the result of a complex interplay between environment, genetics, and even viral factors. Understanding the causes helps guide prevention strategies.

Cause/Risk Factor	Role in Pterygium Development	Mechanism	Sources
UV light exposure	Major risk factor	DNA damage, inflammation	9 4 10 13 12
Dry, dusty, windy climates	Increases risk	Chronic irritation	4 5 9
Age	Risk increases with age	Cumulative exposure	9 8 3
Outdoor occupation	Higher incidence	More sun exposure	9 5 4
Genetics	Familial cases observed	DNA repair gene defects	10 11
Viral infections	Associated with HPV in some cases	Altered cell behavior	11 12 13
Smoking	Protective effect observed	Unknown	9
Sunglasses usage	Reduces risk	UV protection	9

Table 3: Main Causes and Risk Factors

Environmental and Lifestyle Factors

Ultraviolet (UV) Light

The single most important risk factor is long-term exposure to UV radiation. People living in sunny climates, especially those who work outdoors, are at much higher risk. UV rays cause DNA damage and trigger inflammation, setting the stage for abnormal tissue growth 9 4 10 13.

Climate and Irritants

Hot, dry, and dusty environments contribute to the development and progression of pterygium by chronically irritating the eye’s surface 4 5 9.

Age, Occupation, and Lifestyle

• Age: The risk rises steadily with age, with the highest prevalence in older adults 9 8 3.
• Occupation: Farmers, fishermen, and outdoor workers are especially vulnerable due to increased sun and environmental exposure 9 5 4.
• Protective Measures: Regular use of sunglasses provides significant protection, decreasing risk by more than half 9.

Genetic and Molecular Factors

Recent research points to a genetic component: mutations or defects in genes responsible for cell growth, DNA repair (notably the p53 gene), and angiogenesis are implicated 10 11 13.

Other Contributing Factors

• Viral Infections: Human papillomavirus (HPV) has been detected in some cases of pterygium, suggesting a possible role in certain populations 11 12 13.
• Smoking: Surprisingly, some studies show a protective effect of smoking, though the mechanism is unclear and not recommended as a preventive measure 9.

Pathophysiology: How Does Pterygium Form?

• Chronic UV exposure leads to DNA damage and abnormal repair, resulting in fibrovascular proliferation.
• Inflammation, oxidative stress, and changes in the extracellular matrix allow conjunctival tissue to invade the cornea.
• Additional factors include viral infections and possibly bone marrow-derived progenitor cells, indicating a multifactorial origin 10 11 12 13.

Treatment of Pterygium

Managing pterygium focuses on relieving symptoms, preventing progression, and minimizing recurrence after surgery. Treatment options have evolved significantly, offering better outcomes and improved quality of life.

Treatment	Main Benefit	Limitation/Recurrence	Sources
Lubricant drops	Symptom relief	No effect on growth	4 14
Steroid/NSAID eye drops	Reduces inflammation	Temporary, not curative	3 14
Excision (Bare sclera)	Removes growth	High recurrence (up to 80%)	14 15 16
Conjunctival autograft	Low recurrence, safe	More complex surgery	15 16 17 18
Amniotic membrane graft	For large/recurrent cases	Higher recurrence than autograft	15 17
Mitomycin C/Beta-irradiation	Lowers recurrence	Potential complications	14 16 18
Ciclosporin/Bevacizumab drops	Adjuncts to surgery	Still under study	18
Sunglasses/UV protection	Prevents progression	Preventive only	9 4

Table 4: Treatment Options and Outcomes

Non-Surgical Management

Lubricating and Anti-Inflammatory Drops

Artificial tears and lubricants can alleviate symptoms like irritation and dryness. Steroid or NSAID drops may be used short-term to reduce inflammation, but these do not halt or reverse pterygium growth 4 14.

Prevention

Consistent use of sunglasses and wide-brimmed hats can help prevent both the development and progression of pterygium, especially in high-risk individuals 9 4.

Surgical Treatment

Surgery is indicated for:

• Progressive or vision-threatening pterygia
• Significant discomfort unresponsive to medication
• Cosmetic concerns affecting quality of life 2 4 5 14 15

Surgical Techniques

• Bare Sclera Excision: The growth is removed, but the uncovered sclera leads to very high recurrence rates—up to 80% 14 15 16. This approach is now largely outdated.
• Conjunctival Autograft: A piece of healthy conjunctiva from the same eye is transplanted to cover the excised area. This significantly reduces recurrence and is considered the gold standard 15 16 17.
• Amniotic Membrane Graft: Used in cases with extensive tissue loss or recurrent pterygium, but recurrence rates are generally higher than with autograft 15 17.

Adjunctive Therapies

• Mitomycin C (MMC): An anti-scarring agent applied during or after surgery to reduce recurrence. Needs careful use due to risk of complications 14 16 18.
• Beta-irradiation: Used in some centers, it also lowers recurrence but carries risks for long-term eye health 16.
• Ciclosporin/Bevacizumab: Newer adjuncts showing promise when combined with autograft surgery 18.

Recurrence and Patient Satisfaction

Modern techniques, particularly conjunctival autograft with adjunctive therapies, have dramatically reduced recurrence rates, and most patients report high satisfaction and symptom relief after surgery 2 15 17 18.

Conclusion

Pterygium is a multifaceted eye condition with significant impacts on comfort, vision, and quality of life. Here’s a quick summary of what we’ve covered:

• Symptoms: Include redness, foreign body sensation, tearing, irritation, blurred vision, and cosmetic concerns.
• Types: Classified by location, laterality, progression, and recurrence; progressive types cause more symptoms and are more likely to affect vision.
• Causes: Strongly linked to UV exposure, with roles for age, occupation, climate, genetics, and possibly viral infections.
• Treatment: Ranges from lubricants and anti-inflammatory drops to advanced surgical approaches. Conjunctival autograft is the current gold standard, especially when combined with adjunctive therapies to minimize recurrence.
• Prevention: Protective eyewear and minimizing sun exposure are key strategies, especially for those at high risk.

Understanding pterygium enables patients and clinicians to make informed choices, leading to better eye health and improved life quality. If you suspect you have a pterygium or are experiencing any of these symptoms, consult an eye care professional for assessment and guidance.