Pterygium – Dr. David J. Schanzlin Answers Questions About this Common Eye Condition
A pterygium is a very common condition, particularly here in the San Diego area. Characterized by an abnormal growth over surface tissues of the eye, a pterygium can get progressively worse and ultimately affect the cornea. When left untreated, this condition can cause distorted vision, excessive tearing, eye irritation, eye discoloration, cosmetic changes to the eye, and other debilitating symptoms. Dr. David J. Schanzlin, one of our experienced eye doctors here at Gordon Schanzlin New Vision Institute, performs a number of advanced pterygium removal treatments that can successfully address the problem and reduce the chances of recurrence. He recently answered a number of questions about the condition to explain how a pterygium typically develops as well as the pros and cons of specific treatments.
What causes a pterygium?
“We believe a pterygium is caused by ultraviolet light exposure. That’s why they usually occur at the inner or outer aspects of the cornea within the opening of the eyelid. They are more common in people who are closer to the equator, and in people who spend a lot of time near the water. It’s very common in San Diego. If you’ve spent a lot of time outdoors sun tanning or in the water, the ultraviolet light reflects off the surface of the water and we get overexposed in the surface of the eye. Once you’ve developed it, you’ve always got that tendency. Even once the problem has been repaired, it sometimes comes back because the tissue is so sensitive to inflammation.”
What are some of the treatment options available for pterygium removal?
“There are three major techniques: 1. Basic excision of the pterygium. 2. Excision with use of the amniotic membrane. 3. Excision with the use of a conjunctival transplant. The conjunctiva is the tissue that covers the white of the eye where the pterygium is located.
The first option (what’s known as the bare sclera technique) removes the pterygium and leaves the white of the eye exposed. The sclera can also be covered by closing the surrounding tissues and drawing them together with sutures. The second technique involves removal of the pterygium and replacement with an amniotic membrane graft. The third technique removes the pterygium and replaces it with a piece of conjunctiva that comes from the patient (a conjunctival transplant).”
Learn more about pterygium.
What goes into determining which treatment is the best option for one’s specific needs?
“If somebody has a very small pterygium, very close to the colored part of the eye, and we don’t have to remove a wide area of tissue, then we do the simplest procedure – which is the basic excision. We’ve found that, if we have to remove more than 5 millimeters of the conjunctival tissue, it is difficult to get it to heal over the white of the eye without having a fibrous reaction and the regrowth that causes recurrence. So, to get around that and to be able to control the healing process better, we use a small piece of amniotic membrane. We take about a 5mm segment of that and glue it to the surface in the white of the eye. We attach surrounding tissue to the edge of it so that it can grow back in a very controlled fashion. This can reduce the chance of recurrence.
“A conjunctival transplant is an older technique. It is probably the most successful technique to be used; however, because the patient’s own tissue is utilized, you are sacrificing some of the covering of the surface of the eye. A wide area of tissue is excised and attached over the area where the pterygium has been removed. It’s the best technique, but it puts you more at risk of dry eye syndrome later in life. This procedure is often reserved for patients who have a recurrence after treatment with the amniotic membrane technique. Pterygium regrowth after treatment using the amniotic membrane technique is at about 5%. With conjunctival transplant surgery, the chance of recurrence is probably about 2%. Recurrence with the bare sclera technique is about 10%, which is one reason why I rarely perform this technique anymore. It’s really all about limiting the damage and the potential for recurrence as much as possible, which is why some techniques are often more preferable than others.”
What can patients expect during the recovery process?
“Usually patients go home with a patch on the eye, which we have them remove after about two or three hours. When it’s removed, the patient often has a feeling of irritation on the surface of the eye, but there is usually no pain involved. It can feel like a lump or something caught in the eye. This typically lasts until the next morning, and by then any discomfort should be minimal to none. Medication can be used to manage the discomfort.”
Contact Gordon Schanzlin New Vision Institute
If you would like more information on pterygium conditions and treatment options that may be ideal for your needs, or if you would like to schedule a consultation, please contact Gordon Schanzlin New Vision Institute today.