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Pinguecula and Pterygium

By Michelle Stephenson; reviewed by Charles Slonim, MD

Has your doctor told you that you might have a pinguecula or a pterygium? These two eye growths are often confused, so read on to learn the differences.

Pinguecula

Pingueculae are yellowish, slightly raised lesions that form on the surface of the white part of your eye (sclera) close to the edge of the cornea. They are typically found in the open space between your eyelids (palpebral fissure), which also happens to be the area exposed to the sun.

While pingueculae are more common in middle-aged or older people who spend a lot of time in the sun, they can also be found in younger people and even children — especially those who are often outdoors without protection such as sunglasses or hats.

Pinguecula Signs and Symptoms

In most people, pingueculae cause few symptoms. But a pinguecula that is irritated might create a feeling that something is in the eye.

In some cases, pingueculae become swollen and inflamed, a condition called pingueculitis. Irritation and eye redness from pingueculitis usually result from exposure to sun, wind, dust or extremely dry conditions.

Treatment of Pinguecula

Pinguecula treatment depends on how severe the symptoms are. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for mild pingueculitis, to relieve dry eye irritation and foreign-body sensation. Steroid eye drops or nonsteroidal anti-inflammatory drugs may be needed to relieve significant inflammation and swelling.

Surgical removal of the pinguecula may be considered in severe cases when it interferes with vision, contact lens wear or blinking.

Frequently, pingueculae can lead to the formation of pterygia.

Pterygium

Pterygia are wedge- or wing-shaped growths of benign fibrous tissue with blood vessels (fibrovascular), typically located on the surface of the sclera. In extreme cases, pterygia may grow onto the eye's cornea and interfere with vision.

Because a pterygium resembles tissue or film growing over the eye, a person who has one may become concerned about personal appearance.

As with pingueculae, prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia.

Pterygium Signs and Symptoms

Many people with pterygia do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a feeling of having a foreign body in the eye.

Large and advanced pterygia can actually cause a distortion of the surface of the cornea and cause astigmatism.

If a pterygium becomes large or inflamed, surgical removal may be necessary.

How a Pterygium Is Treated

Treatment depends on the pterygium's size and the symptoms it causes. If a pterygium is small but becomes inflamed, your eye doctor may prescribe lubricants or possibly a mild steroid eye drop to reduce swelling and redness. In some cases, surgical removal of the pterygium is necessary.

The pterygium may be removed in a procedure room at the doctor's office or in an operating room setting. A number of surgical techniques are currently used to remove pterygia, and it is up to your eye doctor to determine the best procedure for you.

For milder pterygia, a topical anesthetic can be used before surgery to deaden feeling in your eye's surface. Your eyelids will be kept open with an eyelid speculum while the pterygium is surgically removed. After the procedure, which usually lasts no longer than half an hour, you likely will need to wear an eye patch for protection for a day or two. You should be able to return to work or normal activities the next day.

Exposure to ultraviolet light from the sun is a suspected cause of pingueculae and pterygia. Wrap sunglasses, such as these from Oakley, will protect your eyes from all angles.

Unfortunately, pterygia often return after surgical removal. In fact, the recurrence rate is between 3 and 40 percent. To prevent regrowth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, is very safe and has a low recurrence rate.

A drug that slows metabolic processes (antimetabolite) contributing to tissue growth, such as mitomycin, may be applied topically.

After removal of the pterygium, steroid eye drops may be used for several weeks to decrease swelling and prevent regrowth.

Note that pterygium removal also can induce astigmatism, especially in people who already have astigmatism.

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[Page updated January 2009]