PTERYGIUM (OP3.
6)
DR HANUMANT MANDLIK,
PROFESSOR, DEPT OF OPHTHALMLOGY,
B.V.D.U. M.C.H., SANGLI.
S.L.O.s
• Define pterygium.
• Describe etiology and pathophysiology of
pterygium.
• Describe clinical features of pterygium.
• Discuss differential diagnosis of pterygium.
• Describe management of pterygium.
PTERYGIUM:
Pterygion = wing
• Triangular wing-shaped fleshy fibrovascular mass or
fold of conjunctiva encroaching upon the cornea
from either side within the interpalpebral fissure.
• Etiology:
• Common in people living in hot climate
• exposed to sunlight and dust
s
PTERYGIUM:
Pathology:
Degenerative and hyperplastic condition of
conjunctiva
Elastotic degeneration and proliferates as vascularised
granulation tissue under the epithelium
Ultimately encroaches the cornea
Corneal epithelium, Bowman's layer and
superficial stroma are destroyed
PTERYGIUM:
• Clinical features:
• FB sensation, watering, discomfort, visual disturbance
• Cosmetic disfigurement
• Common in outdoor working males
• Unilateral or bilateral
• Mostly on nasal side, temporal side not spared
• Iron Deposition seen in corneal epithelium (stocker’s
line)
PTERYGIUM:
Parts of a fully developed pterygium:
Head (apical part)
Neck (limbal part)
Body (scleral part)
cap -Few infiltrates in the
Cornea in front of the head
of the pterygium
Johnston classification
Stages of Pterygium
• Stage 0: the lesion is posterior to the limbus , specifically called
pinguecula..
• Stage 1: the lesion involves limbus. Minimal papillary response is seen
and conjunctival and corneal tissues are flat.
• Stage 2: the lesion appears just on the limbus. The vascularity is normal
but a minimal elevation is observed on conjuctival and corneal tissues.
• Stage 3: covers the area between the limbus and pupillary margin.
Moderate vascularity with vessel congestion is seen and the lesion is
upto 1 mm.
• Stage 4: the lesion is central to the pupillary margin. It extends to more
than 1 mm. -a severe
form of pterygium with vessel congestion and dilation. dense and
deep color and may involve areas of vision (visual axis). This is associated
with increase in astigmatism and can even lead to limitation of eye
movement.
Types of Pterygium:
Progressive:
Thick, fleshy,vascular
Few infiltrates in the cornea,
in front of the head of the pterygium –cap
Regressive:
Thin, atrophic, attenuated, very little vascularity.
There is no cap.
Ultimately it becomes membranous but never
disappears
PTERYGIUM:
Differential Diagnosis:
• Pseudo pterygium is a fold of bulbar conjunctiva
attached to the cornea.
• formed due to adhesions of chemosed bulbar
conjunctiva to the marginal corneal ulcer.
• usually occurs following chemical burns of the eye
PTERYGIUM: Treatment:
Only satisfactory is SURGERY
Indications:
Cosmetic
Continued progression
Diplopia due to interference of ocular
movements
PTERYGIUM:
Treatment:
Recurrence is very common
Can be reduced by following:
• Transplantation of pterygium in the lower
fornix
• Postoperative beta irradiations
• Postoperative / intraoperative use of
antimitotic drugs (mitomycin-C or thiotepa)
• Surgical excision with bare sclera
• Surgical excision with free conjunctival graft
or amniotic membrane graft
• Excision with lamellar keratectomy and
lamellar keratoplasty.
Surgical technique of pterygium excision
1. After local anaesthesia, eye is cleansed, draped and
exposed using universal eye speculum.
2. Head of the pterygium is lifted and dissected off the
cornea very meticulously
3. The main mass of pterygium is then separated from
the sclera underneath and the conjunctiva.
4. Pterygium tissue is then excised taking care not to
damage the underlying medial rectus muscle.
5. Haemostasis is achieved and the episcleral tissue
exposed is cauterised thoroughly.
Surgical technique of pterygium excision
6. Next step differs depending upon the technique adopted
i. Simple excision the conjunctiva is sutured back.
ii. Bare sclera technique-part of conjunctiva is excised and its
edges are sutured to the underlying episcleral tissue leaving
some bare part of sclera near the limbus.
iii. Free conjunctival membrane graft -to cover the bare sclera.
--more effective in reducing recurrence.
-Free conjunctiva from the same or opposite eye may be used
iv. Limbal conjunctival autograft transplantation (LLAT) to cover
the defect after pterygium excision is the latest and most
effective technique in the management of pterygium.
v. Amniotic membrane graft
PTERYGIUM: Treatment: Surgical
steps:
PTERYGIUM: Treatment: Surgical
steps:
