Pterygium: Causes, Symptoms, Treatment

The condition referred to as “fish eye” in English is actually known as pterygium or pinguecula in medical terminology. Pterygium is a common eye disorder that affects the conjunctiva, which is the thin, transparent membrane covering the white part of the eye (sclera).

Understanding Pterygium

1. Symptoms and Causes:
   Pterygium often presents as a raised, wedge-shaped growth on the surface of the eye, typically starting on the side closest to the nose. It can vary in size and color, appearing whitish, pink, or red. Some common symptoms include eye irritation, redness, a gritty sensation, and sometimes blurry vision if the growth encroaches on the cornea, which is the clear covering over the iris and pupil.

   The exact cause of pterygium isn’t fully understood, but it is believed to be related to excessive exposure to ultraviolet (UV) light, particularly from sunlight. Other contributing factors may include dry eyes, environmental factors like dust and wind, and genetic predisposition.

2. Diagnosis:
   Diagnosis of pterygium is typically done through a comprehensive eye examination by an ophthalmologist. The doctor will evaluate the appearance of the growth, assess its size and progression, and may use special dyes or imaging tests to examine the extent of involvement on the cornea.

3. Treatment Options:
   Treatment for pterygium depends on the severity of symptoms and the extent of growth. In mild cases where the growth is small and asymptomatic, no treatment may be necessary other than regular monitoring to track any changes.

   However, if the pterygium is causing discomfort, affecting vision, or showing signs of progression, several treatment options may be considered:

   • Artificial Tears: Lubricating eye drops can help relieve dryness and irritation associated with pterygium.
   • Steroid Eye Drops: These can be prescribed to reduce inflammation and redness.
   • Surgical Removal: If the pterygium is large, causing significant vision problems, or not responding to other treatments, surgical removal may be recommended. During this procedure, known as a pterygium excision, the growth is carefully removed, and a graft may be placed to cover the area and reduce the likelihood of recurrence.

4. Post-Surgery Care:
   After surgical removal of a pterygium, patients are typically advised to follow specific post-operative care instructions, which may include:

   • Using prescribed eye drops to prevent infection and promote healing.
   • Avoiding rubbing or touching the eyes.
   • Wearing protective eyewear, such as sunglasses, to shield the eyes from UV light and environmental irritants.
   • Attending follow-up appointments with the ophthalmologist to monitor healing and address any concerns.

5. Prevention:
   While pterygium cannot always be prevented, some measures can help reduce the risk of developing or worsening the condition:

   • Wearing sunglasses that block both UVA and UVB rays when outdoors.
   • Using protective eyewear, such as goggles, in windy or dusty environments.
   • Taking breaks and resting the eyes during prolonged periods of screen use or intense visual activities.
   • Keeping the eyes well-lubricated with artificial tears if prone to dryness.

Conclusion

In summary, pterygium, often referred to as “fish eye,” is a common eye condition characterized by a growth on the conjunctiva. While it may not always require treatment, especially in mild cases, symptoms like irritation and vision changes may necessitate interventions such as artificial tears, steroid eye drops, or surgical removal. Preventive measures, including UV protection and eye care practices, can also play a crucial role in managing and minimizing the impact of pterygium on eye health.

Certainly, here’s an expanded version of the information on pterygium:

Anatomy and Pathophysiology

Pterygium originates from the conjunctiva, a thin, transparent tissue covering the white part of the eye and the inside of the eyelids. The exact cause of its development is multifactorial. Chronic exposure to ultraviolet (UV) radiation, particularly from sunlight, is a significant risk factor. UV light exposure can lead to changes in the conjunctival cells, causing them to proliferate abnormally and form a pterygium.

Other contributing factors include dry eye syndrome, which can result from reduced tear production or poor tear quality. Environmental factors such as dust, wind, and pollutants can also irritate the eyes, potentially triggering the development or exacerbation of pterygium.

Genetics may also play a role, as some individuals may have a genetic predisposition to developing pterygium. Additionally, certain occupations or activities that involve prolonged outdoor exposure, such as farming, fishing, and construction work, are associated with a higher incidence of pterygium.

Clinical Presentation and Diagnosis

Pterygium typically presents as a raised, triangular or wing-shaped growth on the nasal side of the eye, although it can occur on the temporal side as well. The growth may have a whitish, pink, or red appearance, depending on its vascularity and degree of inflammation. In some cases, a yellowish fatty deposit called pinguecula may precede the development of pterygium.

Symptoms of pterygium can vary but often include:

• Eye irritation, itching, or burning sensation
• Redness and inflammation of the affected eye
• Foreign body sensation or grittiness
• Blurred vision, especially if the growth encroaches on the cornea
• Dry eyes, which may exacerbate symptoms

Diagnosis of pterygium is made through a comprehensive eye examination by an ophthalmologist. The doctor will carefully evaluate the appearance and size of the growth, assess its impact on vision and ocular surface health, and may use additional tests such as slit-lamp examination, corneal topography, or anterior segment photography to document the extent of involvement.

Treatment Modalities

The management of pterygium depends on various factors, including the size and location of the growth, the presence of symptoms, and the patient’s overall ocular health. Treatment options range from conservative measures to surgical intervention.

1. Conservative Management:

   • Artificial Tears: Lubricating eye drops or ointments can help alleviate dryness and discomfort associated with pterygium. They may be used regularly to maintain ocular surface health.
   • Steroid Eye Drops: Short-term use of topical corticosteroids can reduce inflammation and redness, especially during flare-ups or acute episodes of irritation.
   • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications may be prescribed to manage pain and inflammation, particularly if there is significant discomfort.

2. Surgical Intervention:

   • Pterygium Excision: Surgical removal of the pterygium is considered when conservative measures are ineffective, or the growth causes vision problems, significant irritation, or cosmetic concerns. During the procedure, the surgeon carefully excises the pterygium and may use techniques such as conjunctival autograft or amniotic membrane transplantation to cover the exposed area and reduce the risk of recurrence.
   • Adjunctive Therapies: In some cases, adjuvant treatments such as beta-irradiation, mitomycin-C application, or fibrin glue may be used during or after pterygium excision to improve surgical outcomes and reduce recurrence rates.

Postoperative Care and Follow-Up

After surgical removal of a pterygium, patients are instructed to follow specific postoperative care guidelines to promote healing and reduce the risk of complications:

• Topical Medications: Patients may be prescribed antibiotic and steroid eye drops to prevent infection, reduce inflammation, and promote tissue healing.
• Eye Protection: Wearing protective eyewear, such as sunglasses with UV protection, is recommended to shield the eyes from sunlight and environmental irritants during the recovery period.
• Avoiding Eye Strain: Patients are advised to avoid strenuous activities, heavy lifting, or activities that may strain the eyes during the initial healing phase.
• Follow-Up Visits: Regular follow-up appointments with the ophthalmologist are scheduled to monitor postoperative progress, evaluate healing, and address any concerns or complications promptly.

Prognosis and Complications

The prognosis for pterygium is generally favorable, especially with early detection and appropriate management. Most cases can be effectively treated with conservative measures or surgical intervention, leading to symptom relief and improved ocular comfort.

However, complications associated with pterygium and its treatment may include:

• Recurrence: Despite surgical removal, pterygium can recur, particularly if preventive measures are not followed or if there are underlying risk factors such as ongoing UV exposure.
• Corneal Involvement: In advanced cases, pterygium may extend onto the cornea, causing irregular astigmatism, visual distortion, or corneal scarring.
• Dry Eye Syndrome: Pterygium and its treatment can contribute to dry eye symptoms, requiring ongoing management with lubricating eye drops or other therapies.
• Cosmetic Concerns: Large or prominent pterygium can be cosmetically bothersome, especially if it affects the appearance of the eye or eyelid.

Prevention Strategies

While it may not be possible to prevent pterygium entirely, adopting certain preventive strategies can help reduce the risk of its development or recurrence:

• UV Protection: Wearing sunglasses that block both UVA and UVB rays, along with wide-brimmed hats or visors, can significantly reduce UV exposure to the eyes.
• Eye Hygiene: Practicing good eye hygiene, such as avoiding eye rubbing, maintaining adequate blink frequency, and using artificial tears if prone to dryness, can help protect the ocular surface.
• Regular Eye Examinations: Routine eye exams by an eye care professional can aid in early detection of pterygium or other ocular conditions, allowing for timely intervention and management.

By implementing these preventive measures and seeking prompt medical attention for any ocular symptoms or concerns, individuals can help safeguard their eye health and reduce the impact of conditions like pterygium on visual function and quality of life.