A pterygium is a non-cancerous growth that develops on the surface of the eye, often referred to as “surfer’s eye” due to its association with outdoor exposure. Pterygium excision with conjunctival autograft is a common surgical procedure to remove this growth and minimize its return. This approach combines the removal of the abnormal tissue with the transplantation of healthy tissue from the patient’s own eye, aiming for effective treatment and long-term stability.
Understanding Pterygium and Surgical Need
A pterygium appears as a fleshy, triangular growth on the conjunctiva, the clear membrane covering the white part of the eye, and can extend onto the cornea. It commonly originates from the inner corner of the eye, nearer to the nose, but can also occur on the outer corner and in one or both eyes. While the exact cause is not fully understood, prolonged exposure to ultraviolet (UV) light, dust, wind, and dry weather are considered primary contributing factors.
In its early stages, a pterygium may not cause any symptoms. As it progresses, individuals might experience redness, irritation, a burning sensation, itching, or a feeling of having a foreign object in the eye. If the growth extends over the cornea and approaches or covers the pupil, it can lead to blurred vision, astigmatism (a distortion of the cornea), or even double vision. Surgery becomes necessary when the pterygium significantly impairs vision, causes persistent discomfort not relieved by eye drops, or becomes a cosmetic concern.
The Surgical Process
Pterygium excision with conjunctival autograft is an outpatient procedure, meaning the patient can go home the same day. The surgery is performed under local anesthesia, with medication injected into the conjunctiva near the pterygium and the graft harvest site, ensuring comfort during the procedure. The eye is kept open with a specialized clamp, and a microscope is used to provide magnified views for the surgeon.
First, the pterygium is carefully separated from the corneal surface using scissors or a blade, then excised from its base. Any abnormal scar tissue on the corneal surface and wound bed is then scraped away to create a smooth surface. The “conjunctival autograft” component involves harvesting a small, thin piece of healthy conjunctiva from the patient’s own eye, typically from under the upper eyelid or the superior temporal region.
This harvested conjunctival tissue is then transplanted to cover the exposed sclera (the white part of the eye) where the pterygium was removed. The graft is secured in place using either dissolvable sutures or a biological tissue adhesive called fibrin glue. Fibrin glue is favored as it can reduce postoperative inflammation and discomfort, and may shorten operating time compared to sutures. The primary benefit of using an autograft is its effectiveness in significantly reducing the chance of pterygium recurrence compared to simply removing the growth alone.
Post-Surgery Care and Recovery
Immediately after pterygium surgery, an eye patch may be applied, removed within 24 hours. It is common to experience some discomfort, redness, and a feeling like a foreign object is in the eye. Mild pain, tearing, and light sensitivity are expected in the initial days.
To prevent infection and reduce inflammation, patients are prescribed eye drops, including antibiotics and steroids. These drops are used for several weeks to months, with tapering schedules provided by the ophthalmologist. Lubricating eye drops may also be recommended to soothe the eye and manage dryness.
Activity restrictions are important for proper healing. Patients are advised to avoid rubbing or pressing the operative eye for at least three months. Strenuous activities, heavy lifting, and bending over should be avoided for several weeks (three to four weeks). Avoid getting soap or water in the eye for about three weeks, and refrain from swimming or dusty environments for approximately one month. Follow-up appointments with the ophthalmologist are scheduled to monitor healing and address any concerns.
Long-Term Outlook and Recurrence Prevention
Pterygium excision with conjunctival autograft has a high success rate in achieving clear vision and improving the eye’s cosmetic appearance. The transplantation of healthy conjunctival tissue significantly lowers the risk of the pterygium growing back compared to older surgical methods without a graft. While recurrence rates vary between studies, they are generally low, ranging from approximately 2% to 10%.
Even with an autograft, recurrence can occur. Factors like incomplete tissue removal, persistent fibrotic debris, or patient-specific conditions like age can influence this risk. Most recurrences occur within the first three months after surgery. To minimize the risk of recurrence and prevent the formation of new pterygia, long-term eye protection is strongly emphasized.
Wearing high-quality sunglasses that block UV light and wide-brimmed hats is recommended whenever outdoors. These measures shield the eyes from UV radiation, wind, and dust, known contributors to pterygium development. While rare, potential long-term complications can include infection, loss of transparency in the treated area, corneal thinning, or scar tissue formation. Ongoing follow-up with an eye care professional ensures continued eye health and allows for early detection and management of issues.