Pterygium, often called “surfer’s eye,” is a common, non-cancerous growth that begins on the conjunctiva (the clear membrane covering the white part of the eye) and extends toward the cornea. This wedge-shaped tissue growth is strongly associated with prolonged exposure to ultraviolet (UV) light, wind, and dust. Pterygium surgery is a generally safe and effective outpatient procedure, but like any surgical intervention, it carries risks that patients should understand. The primary goal of the procedure is to remove the abnormal tissue and prevent its return.
When is Pterygium Surgery Necessary
Surgery is not automatically recommended for every case of pterygium, especially if the growth is small and causes only mild irritation manageable with topical eye drops. The decision to proceed with surgical removal is primarily based on functional impairment or a significant threat to vision. A major indication for surgery is when the pterygium begins to encroach upon the visual axis, meaning the growth has extended far enough onto the cornea to obstruct the pupil.
The growth can also induce or worsen astigmatism, a refractive error where the corneal curvature is irregular, leading to blurred or distorted vision that cannot be corrected with glasses or contact lenses. Furthermore, if the pterygium causes severe, chronic inflammation, redness, or a foreign-body sensation that does not respond to anti-inflammatory or lubricating eye drops, surgery becomes a viable option. Ophthalmologists advise intervention before the growth becomes too large, preventing permanent vision changes.
Immediate Risks and Complications
Pterygium surgery has a high success rate, but patients should be aware of the immediate and subacute risks associated with the procedure. Post-operative discomfort, redness, and temporary blurred vision are common and typically resolve within the first few weeks following the surgery. However, more specific complications are possible, though many are rare.
One concern is the risk of infection, though it is a rare occurrence in pterygium surgery. Minor bleeding or hemorrhage at the surgical site can occur, which is usually self-limiting but may cause temporary bruising or redness. A more frequent, though temporary, issue is irritation related to the sutures used to secure the graft, which can cause significant foreign-body sensation until they dissolve or are removed.
Scarring, or corneal haze, is a more serious complication that can impact the visual outcome if it develops on the area of the cornea previously covered by the pterygium. In rare instances, the procedure can result in globe perforation (penetration of the eyeball) or the development of diplopia (double vision). Double vision is seen when extensive tissue removal is necessary near the eye muscles, a risk that is higher in cases of recurrent pterygia.
Strategies for Preventing Recurrence
The greatest long-term challenge of pterygium removal is the risk of the growth returning, which can occur in a more aggressive form. The gold standard technique to minimize this risk is the use of a Conjunctival Autograft (CAG), which involves transplanting a small, healthy piece of conjunctival tissue to cover the site where the pterygium was removed. This procedure acts as a barrier to the re-growth of the abnormal tissue, lowering recurrence rates to a reported range of 5% to 12% for primary pterygia cases.
Surgeons often use biological glue, such as fibrin adhesive, instead of sutures to secure the autograft, which can reduce patient discomfort and shorten the overall operative time. In select high-risk cases, anti-metabolite medications like Mitomycin C (MMC) may be applied directly to the surgical site during the procedure. These agents inhibit the growth of cells, but their use is measured due to the potential for rare but serious side effects, including corneal or scleral thinning.
Post-operative care also plays a role in prevention. Patients must consistently wear high-quality sunglasses that block UV light and use prescribed topical steroid drops to control inflammation during the healing period.