Pinguecula & Pterygium



  • Degenerative condition of conjunctiva.
  • Characterized by triangular yellowish white patch on the bulbar conjunctiva near the limbus.
  • The apex of triangle being away from the cornea & affects the nasal side first, then the temporal.
  • It is due to hyaline infiltration & elastotic degeneration of sub-mucous tissue.
  • Usually found in elderly people, especially those exposed to strong sunlight, dust, wind etc.
  • Considered as a precursor of pterygium frequently follows a pinguecula.
  • It requires no treatment.


  • Pterygium is a non- cancerous (non-neoplastic) growth of conjunctiva.
  • Characterized by a wing-shaped fold of conjunctiva upon the cornea from either side within the interpalpebral fissure.
  • Pterygium is always situated in the palpebral aperture.
  • Pathologically Pterygium is a degenerative & hyperplastic condition of conjunctiva.
  • The subconjunctival tissue undergoes elastotic degeneration & proliferates as vascularised granulation tissue under the epithelium, which ultimately encroaches the cornea.
  • The corneal epithelium, Bowman’s layer & stroma are destroyed.


  • More common in people with excess outdoor exposure to sunlight (UV rays) dry, heat, high wind & abundance of dust.
  • Clinically, presents as a triangular fold of conjunctiva encroaching the cornea in the area of palpebral aperture, usually on the nasal side.
  • Other findings are stocker’s line (deposition of iron).
  • Pterygium is an asymptomatic condition in the early stages, except for cosmetic intolerance.
  • Visual disturbance or corneal astigmatism ma occur.
  • Visual disturbances are due to encroachment of pterygium on pupillary area or corneal astigmatism.
  • Occasionally diplopia may occur due to limitation of ocular movements.


  • Asymptomatic pterygium which is not progressive is best left alone.

Surgical excision is the only satisfactory treatment & is indicated for:

  1. Cosmetic reasons
  2. Continued progression threatening to encroach onto the papillary area
  3. Diplopia due to interference in ocular movement
  • Simple excision (‘bare sclera’ technique) is associated with high recurrence rate (upto 80%)  that may be more aggressive than the initial lesion.
  • Thus conjunctival autografting is currently most popular approach.
  • Adjunctive treatment with mitomycin c, beta-irradiation, & amniotic membrane patch grafting can also be used for aggressive lesions.

Exam Important


  • Pterygium is Connective tissue proliferation.
  • Cause of blindness in pterygium is Astigmatism.
  • Drug used to avoid recurrence of pterygium is Mitomycin C.
  • The histology of pterygium includes Elastotic degeneration.
  • Lacy white lesion in mouth with pterygium is seen in Lichen planus.


  • Degenerative condition of conjunctiva.
  • Characterized by triangular yellowish white patch on the bulbar conjunctiva near the limbus.
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