Pinguecula & Pterygium

PINGUECULA & PTERYGIUM

Q. 1

Pterygium is:

 A

Vascular anomaly

 B

Connective tissue proliferation

 C

Inflammatory condition

 D

Associated with Vit. A deficiency

Q. 1

Pterygium is:

 A

Vascular anomaly

 B

Connective tissue proliferation

 C

Inflammatory condition

 D

Associated with Vit. A deficiency

Ans. B

Explanation:

A pterygium is a proliferation of fibrovascular tissue on the surface of the eye, which extends onto the cornea. The etiology of pterygium is incompletely understood. However, chronic UV exposure is accepted as a causative agent.

Treatment options:
Pterygia are usually treated only when they interfere with vision. The standard therapy is surgical removal. Pterygia affect astigmatism and are associated with increased rates of macular degeneration; however, it is unclear whether treatment reduces this risk.
Eyes with a pterygium or previous pterygium surgery (but not pinguecula) have a higher risk of incident late age-related maculopathy (ARM) (OR 3.3, 95% CI 1.1–10.3) and early ARM (OR 1.8, 95% CI 1.1–2.9).
Ref: Chumley H. (2009). Chapter 11. Pterygium. In R.P. Usatine, M.A. Smith, H. Chumley, E. Mayeaux, Jr., J. Tysinger (Eds), The Color Atlas of Family Medicine.

Q. 2

Lacy white lesion in mouth with pterygium is seen in :

 A

Psoriasis

 B

Ptirysis alba

 C

Lichen planus

 D

Leprosy

Q. 2

Lacy white lesion in mouth with pterygium is seen in :

 A

Psoriasis

 B

Ptirysis alba

 C

Lichen planus

 D

Leprosy

Ans. C

Explanation:

C. Lichen planus


Q. 3

10 year old chid has violaceous papule and pterygium of nails. The diagnosis is

 A

Psoriasis

 B

Pemphigus

 C

Pemphigoid

 D

Lichen Planus

Q. 3

10 year old chid has violaceous papule and pterygium of nails. The diagnosis is

 A

Psoriasis

 B

Pemphigus

 C

Pemphigoid

 D

Lichen Planus

Ans. D

Explanation:

D i.e. Lichen planus

Quiz In Between


Q. 4

Pterygium all are true except:

 A

Arise from any part of conjunctiva

 B

Can cause astigmatism

 C

Surgery is treatment of choice

 D

UV exposure is risk factor

Q. 4

Pterygium all are true except:

 A

Arise from any part of conjunctiva

 B

Can cause astigmatism

 C

Surgery is treatment of choice

 D

UV exposure is risk factor

Ans. A

Explanation:

A. i.e. Arise from any part of conjunctiva


Q. 5

The histology of pterygium includes:

 A

Elastotic degeneration

 B

Epithelial inclusion bodies

 C

Precancerous changes

 D

Squamous metaplasia of the epithelium

Q. 5

The histology of pterygium includes:

 A

Elastotic degeneration

 B

Epithelial inclusion bodies

 C

Precancerous changes

 D

Squamous metaplasia of the epithelium

Ans. A

Explanation:

Ans. Elastotic degeneration


Q. 6

Pterygium all are true except:

 A

Arise from any part of conjunctiva

 B

Can cause astigmatism

 C

Surgery is treatment of choice

 D

UV exposure is risk factor

Q. 6

Pterygium all are true except:

 A

Arise from any part of conjunctiva

 B

Can cause astigmatism

 C

Surgery is treatment of choice

 D

UV exposure is risk factor

Ans. A

Explanation:

Ans. Arise from any part of conjunctiva

Quiz In Between


Q. 7

Drug used to avoid recurrence of pterygium:

March 2011

 A

Amphotericin-B

 B

Netilmycin

 C

Griesofulvin

 D

Mitomycin C

Q. 7

Drug used to avoid recurrence of pterygium:

March 2011

 A

Amphotericin-B

 B

Netilmycin

 C

Griesofulvin

 D

Mitomycin C

Ans. D

Explanation:

Ans. D: Mitomycin- C

A pterygium sometimes recurs after removal. Post-operative therapy with Mitomycin-C drops has been tried, but complications such as scleral necrosis, cataract and iritis have been reported

Pterygium/ Surfer’s Eye

  • It most often refers to a benign growth of the conjunctiva.
  • A pterygium commonly grows from the nasal side of the sclera.
  • It is usually present in the palpebral fissure.
  • It is associated with, and thought to be caused by ultraviolet-light exposure (e.g., sunlight), low humidity, and dust.
  • Pterygium in the conjunctiva is characterized by elastotic degeneration of collagen (actinic elastosis) and fibrovascular proliferation.
  • It has an advancing portion called the head of the pterygium, which is connected to the main body of the pterygium by the neck.

Sometimes a line of iron deposition can be seen adjacent to the head of the pterygium called Stocker’s line. The location of the line can give an indication of the pattern of growth.

The pterygium is composed of several segments:

–          Fuchs’ Patches (minute gray blemishes that disperse near the pterygium head)

–          Stocker’s Line (a brownish line composed of iron deposits)

–          Hood (fibrous nonvascular portion of the pterygium)

–          Head (apex of the pterygium, typically raised and highly vascular)

–          Body (fleshy elevated portion congested with tortuous vessels)

–          Superior Edge (upper edge of the triangular or wing-shaped portion of the pterygium)

–         Inferior Edge (lower edge of the triangular or wing-shaped portion of the ptyerygium). Symptoms of pterygium

  • It include persistent redness, inflammation, foreign body sensation, tearing, which can cause bleeding, dry and itchy eyes.
  • In advanced cases the pterygium can affect vision as it invades the cornea with the potential of obscuring the optical center of the cornea and inducing astigmatism and corneal scarring

Management

  • As it is a benign growth, pterygium typically does not require surgery unless it grows to such an extent that it covers the pupil, obstructing vision or presents with acute symptoms.
  • Some of the irritating symptoms can be addressed with artificial tears.
  • However, no reliable medical treatment exists to reduce or even prevent pterygium progression.
  • Definitive treatment is achieved only by surgical removal.
  • Long-term follow up is required as pterygium may recur even after complete surgical correction.
  • If there is recurrence after surgery or if recurrence of pterygium is thought to be vision threatening, it is possible to use strontium (90Sr) plaque therapy.
  • 90Sr is a radioactive substance that produces beta particles, which penetrate a very short distance into the cornea at the site of the operation.
  • Conjunctival auto-grafting is a surgical technique that is effective and safe procedure for pterygium removal.
  • Amniotic membrane transplantation with Tisseel glue application and Mitomycin-C has shown excellent cosmetic outcomes with a surface free of redness, stitching, or patches, which makes the ocular surface suitable for vision correction surgery sooner

Q. 8

Cause of blindness in pterygium

 A

Astigmatism

 B

Loss of visual axis

 C

Cataract

 D

Limitation of ocular movements

Q. 8

Cause of blindness in pterygium

 A

Astigmatism

 B

Loss of visual axis

 C

Cataract

 D

Limitation of ocular movements

Ans. A

Explanation:

Ans. is ‘a’ i.e., Astigmatism

Ptervgium

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

Etiology & Clinical features

  • Pterygium is more common in people with excess outdoor exposure to sunlight (UV rays), dry heat, high wind and abundance of dust. Therefore it is more common in those who work outdoors.
  • Clinically it 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)
  • Ptergyium is an asymptomatic condition in the early stages, except for cosmetic intolerance. Visual disturbance or corneal astigmatism may 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 and is indicated for : – (1) Cosmetic reasons, (2) Continued progression threatening to encroach onto the pupillary area (once the pterygium has encroached pupillary area, wait till it crosses on the other side), (3) Diplopia due to interference in ocular movement.

Q. 9

What is the most common problem following surgical treatment of pterygium?

 A

Recurrence

 B

Corneal ulceration

 C

Astigmatism

 D

Scleral scarring

Q. 9

What is the most common problem following surgical treatment of pterygium?

 A

Recurrence

 B

Corneal ulceration

 C

Astigmatism

 D

Scleral scarring

Ans. A

Explanation:

Ans. is ‘a’ i.e., Recurrence

Surgical excision of pterygium is its only satisfactory treatment and is indicated for ‑

  1. Cosmetic reasons
  2. Continued progression threatening to encroach onto the pupillary area (once the pterygium has encroached pupillary area, wait till it crosses on the other side)
  3. Diplopia due to interference in ocular movements.
  • Recurrence of the pterygium after surgical excision is the most common problem after pterigium excision and is seen in 30 – 50 % of the cases.
  • The post operative complications of pterigium surgery are:
  1. Recurrence (most common)
  2. Others : Bleeding, corneal thinning, scarring, fornix loss, symblepharon formation, rectus muscle injury, wound dehiscence, dellen formation, graft chemosis, conjunctival granuloma, epithelial inclusion cysts, astigmatism etc.

Quiz In Between



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