The eyes are an essential part of the body, so it is incredibly important to ensure that they are functioning correctly and not hindered by anything. Unfortunately, a variety of different things can damage the eyes or result in poor eyesight, including the growth of a pterygium. At Wichita Vision Institute, a premier vision correction facility located in Wichita, Kansas, Dr. Patel offers several treatments, surgeries, and other procedures in order to deliver excellent and personalized patient results to help her patients’ eyes and sight.
Yes, pterygia can be removed! Pterygium surgery, a minimally invasive surgery with low risks, can help remove pterygia quickly and safely. In this outpatient surgery, patients are lightly sedated and a professional carefully removes the growth of fleshy tissue.
At the start, patients will be sedated and their eyes will be numbed in order to help prevent discomfort during the surgery. The area will be cleaned and then the doctor will begin to remove any pterygia as well as some of the associated conjunctiva tissue. One the pterygia has been removed, there are several potential courses of action.
This surgical procedure is quick, will take between thirty and forty-five minutes on average, and poses a low risk. It is an outpatient surgical procedure so patients can go home after the surgery to recover. If the patient is suffering from bilateral pterygium, they may need to schedule two surgeries a few months apart to have both eyes treated.
In this option, the tissue of the pterygia is removed and not replaced with tissue graft. The underlying white of the eye is left exposed to heal on its own after the surgery.
However, simply removing pterygia has a high risk of recurrence (between twenty-four percent and eighty-nine percent in studies). It is also possible that any pterygia that regrow after the surgery will be even larger than the initial pterygia. Luckily, the risk of recurrence can be lowered with grafts or medications.
In this process, some tissue is carefully taken from the conjunctiva. It is then glued with fibrin glue (a blood-derived product) or stitched with dissolvable sutures onto the empty space left behind once the pterygia growths have been removed. Recurrence rates of growth vary between 2% and 40% in several studies.
Amniotic membrane transplants can also be helpful in reducing the recurrence of pterygia. The amniotic membrane is obtained from cesarean section and full-term births and is processed to remove blood and antigenic components and decrease the risk of disease transmission. The amniotic membrane can be processed using a dehydration technique, in which high temperatures remove the water content of the tissue, or a cryopreservation technique, in which the amniotic tissue is quickly frozen in order to retain the native architecture of the membrane matrix and the biological activity of the tissue.
After the removal of the pterygia, the piece of amniotic membrane is then fixed to the remaining limbus or the bare sclera area. This can help minimize future growth of pterygia.
Sometimes after the removal of the growth, medications that help prevent the formation of scar tissue and may help prevent the recurrence of pterygia, like mitomycin-C, may be applied to the eye.
Pterygium (or Surfer’s Eye) is a condition in which noncancerous, triangular-shaped growths form on the eye’s conjunctiva. The conjunctiva is the thin, clear tissue that covers the white part of the eye and the growths may grow to cover the cornea. If pterygia affect both eyes, it is called bilateral pterygium. Although these growths are benign, they can result in several annoying symptoms like red eyes, irritation, or the feeling that something is in the eye.
These growths may also start as a yellowish, raised growth caused by a deposit of protein, fat, or calcium on the conjunctiva. These yellowish growths are called pingueculae and have the potential to later develop into pterygia once they have grown in size and spread to the limbus or the cornea.
Pterygia consist of the body, the hood, the head, Fuchs’ Patches, Stocker’s Line, the superior edge, and the inferior edge.
The body is the fleshy, elevated portion which is congested with tortuous vessels, and the hood is a fibrous nonvascular portion. The head is usually raised and highly vascular while tiny gray blemishes called Fuchs’ Patches are dispersed near it. Stocker’s Line is a brownish line made of iron deposits while the superior edge is the upper edge of the triangular portion of the pterygium and the inferior edge is the lower edge.
While no one is sure of the exact cause of this condition, it develops more frequently in those who have experienced excess outdoor exposure to wind, dust, and the sun’s ultraviolet rays. It’s possible that genetics also play a role in the likelihood that someone will develop pterygia in their eyes.
While anyone may develop pterygia, people between the ages of thirty and fifty are the most likely to have pterygia while children rarely suffer from pterygia. It also occurs more often in men than women, though both sexes may suffer from pterygia.
Additionally, people who live near the equator or in another sunny place and spend a lot of time in the sun without eye protection are more likely to develop pterygia. People who play a water sport may also be more likely to develop this condition.
People with larger pterygia may experience a gritty, itchy, or burning sensation as well as a foreign body sensation, or the feeling that something is in the eye. Pterygia may become inflamed which will result in red eyes. Blurry or double vision can also be a result of pterygia.
If pterygia grow large enough, they may invade the cornea and obscure its optical center as well as induce corneal scarring or astigmatism, a condition in which the eye is not completely round, that can cause blurry or distorted vision, eyestrain, or headaches.
Pterygia should be removed if they are negatively impacting a person’s vision. This can happen when they grow large enough to cover part of the cornea, the clear outer layer at the front of the eye that helps it focus light. Pterygia can also cause discomfort, blurry or distorted vision, and have the potential to permanently disfigure the shape of the eye as well as damage eyesight through scarring. In cases in which the patient is experiencing mild symptoms, it may not be necessary to remove the pterygia.
However, some patients may prefer to remove the pterygia for aesthetic or comfort reasons. In some of these mild cases, a doctor may suggest over-the-counter eye ointments, some eye drops to help clear up any redness and irritation, or prescription steroid eye drops to help with the redness, itching, swelling, and pain. Sometimes the symptoms may become resistant to eye drops over time, making surgery a more practical choice as it will be much faster and make a more drastic difference in minimizing symptoms.
Before surgery, patients should have a thorough and honest conversation with their medical providers. They should discuss their symptoms, any medications they are currently taking, any underlying medical conditions, and any previous occurrence of pterygia. They can ask their medical provider any questions they may have.
Before undergoing surgery to remove pterygia, patients should also undergo an eye health and vision evaluation completed which can include taking specific measurements of the eye, eye pressure checks, dry eye evaluation, astigmatism evaluation, and a retina examination. This can help determine whether the patient is a good candidate for the surgery and whether they are suffering from another condition that may need to receive treatment before, after, or simultaneously to the surgery.
Before receiving this surgery, patients may need to only eat a light meal or fast and, if a patient wears contact lenses, they might need to refrain from wearing them for at least twenty-four hours before the procedure. A medical professional will usually give patients a set of guidelines to follow in order to prepare for their surgery which can sometimes include an eyedrop regiment.
After getting pterygia removed and, potentially, receiving a graft or medications that help prevent scar formation, there are a few other things patients may consider doing. Dr. Patel may recommend wearing an eye patch or a pad for protection in the day or two following the surgery and prescribe steroid eye drops to help decrease any swelling and prevent regrowth.
Unfortunately, following surgical removal, it is still possible for pterygia to return. Experiencing continued UV exposure can result in the regrowth of pterygia. Experiencing oxidative stress can also contribute to the return of pterygia. Drugs like mitomycin C may help limit both scarring and abnormal tissue growth during the wound healing process after the completion of the surgery. Following the surgery, these drugs can be usually applied topically to the eye.
While the duration of the recovery process following pterygium surgery varies on an individual basis, most patients can return to their daily activities in two to three days.
Fortunately, there are a few things people can do to minimize their chances at developing new pterygia in the future in addition to following the doctor’s orders for the days immediately following the surgery.
For example, wearing sunglasses with 100% UVA and UVB protection that provide side coverage can help protect the eyes from the ultraviolet light, which is thought to cause the growth of pterygia. Wearing hats to help block out the sun’s harmful ultraviolet rays can also help prevent the growth of pterygia in the future.
Wearing glasses or goggles in dry and dusty areas can also help protect the eyes from tiny dust particles which may contribute to the development of pterygia. Additionally, using artificial tears to help moisturize dry eyes can help minimize the chances of developing pterygia in the future.
If you’d like to find out more, schedule a consultation with Wichita Vision Institute in Wichita, Kansas! Dr. Reena N. Patel, the medical director, is a board-certified, corneal-fellowship-trained physician with extensive training at world-class institutions. She established Wichita Vision Institute in 2004 and will be happy to discuss whether pterygium surgery is the right choice for you.