Pinguecu-WHAT? If you look closely enough, you will notice that lots of people have small growths on their eyes. Two of the most common growths are pterygia and pingueculae. Both occur more frequently in people with a long history of exposure to sun or windy environments and both increase in frequency as we age. For this reason, we recommend that anyone diagnosed with a pinguecula or pterygium wear sunglass or hats when outdoors.
What is a pinguecula?
A pinguecula (pin-GWEK-yoo-lah) is a slightly raised nodule that is typically white or yellowish in color. Although it appears to sit on the “white of the eye,” the sclera, a pinguecula is actually located in a layer of very thin tissue that covers the sclera. This tissue is called the conjunctiva and it covers both the sclera and the inner portions of the eyelids. If you imagine the front of the eye as the face of a clock, pingueculae are usually located at the 3- and 9-o’clock positions because these are the areas between the eyelids that are most exposed to the environment.
Signs, symptoms and treatment
Pinguecula are usually nothing more than a cosmetic concern. Many people are not even aware they have a pinguecula until it is pointed out. In some people, though, pinguecula may cause dry eyes or the sensation that something is in the eye (“foreign body sensation”). For these symptoms, over-the-counter artificial tear drops usually bring some relief. In rare instances, the pinguecula may become inflamed. This condition, called pingueculitis, is often treated with topical steroid eye drops to decrease the inflammation. Surgery is almost never required, but in some cases of chronic inflammation or contact lens intolerance that is related to the pinguecule, surgery may be considered. Pingueculae often lead to the development of pterygia.
What is a pterygium?
A pterygium (teh-RIJ-ee-um) is a wing-shaped growth that begins on the conjunctiva and grows onto the cornea, the clear portion of the eye. The same factors that are thought to play a role in the development of pingueculae are also thought to contribute to pterygia. Unlike pinguecula, pterygia have blood vessels coursing through them, and they are larger, which makes them more cosmetically concerning to patients.
Signs, symptoms and treatment
The symptoms of a pterygium are often similar to those of a pinguecula: dry eye, foreign body sensation and occasional inflammation. Like pinguecula, treatment with artificial tears and judicious use of steroid eye drops is common. However, in some cases, a pterygium may grow so far over the cornea that it interferes with vision, either by blocking the visual axis or inducing astigmatism. In these cases, it is reasonable to consider surgery to remove the pterygium.
Many years ago, pterygium surgery simply meant removing the pterygium and letting the conjunctiva heal. Unfortunately, when surgery was performed in this manner, 50% of pterygia recurred. Today, a graft is taken from the patient’s own conjunctiva (an “autograft”) and used to close the defect in the conjunctiva that remains when the pterygium is removed. Using an autograft reduces the risk of recurrence to less than 10%. Along with all of their fellow ophthalmologists, Drs. Held and Young used to suture (stitch) the autograft into place during pterygium surgery. The end result of this technique was good, but the recovery period was long and the sutures were obviously very uncomfortable for the patient in the week or two before they absorbed. Now, our surgeons utilize the modern tissue adhesive, Tisseel®, to secure the conjunctival graft in place. Using this technique (which is becoming standard of care for all eye surgeons), patients are much more comfortable and the healing process is much faster. An additional bonus of “no-stitch” pterygium surgery with Tisseel® is a reduced rate of recurrence, less than 5%.