PINGUECULA & PTERYGIUM

PINGUECULA

• 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

• 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. 

ETIOLOGY & CLINICAL FEATURES

• 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.

TREATMENT

• 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.

Don’t Forget to Solve all the previous Year Question asked on PINGUECULA & PTERYGIUM
Click Here to Start Quiz