From the Guidelines
The initial management for a patient presenting with a pterygium should be conservative, focusing on symptom relief and prevention of progression, as surgical intervention carries risks of complications such as diplopia, scarring, and recurrence, as noted in the 2024 study on adult strabismus preferred practice pattern 1. When managing a patient with pterygium, the following steps can be taken:
- Prescribe artificial tears such as carboxymethylcellulose or hyaluronic acid drops 4-6 times daily to lubricate the ocular surface and reduce irritation.
- Consider short-term use of mild topical anti-inflammatory medications like loteprednol 0.5% or fluorometholone 0.1% drops 2-4 times daily for 1-2 weeks to manage inflammation during flare-ups.
- Advise patients to wear UV-protective wraparound sunglasses outdoors and avoid environmental irritants such as dust, wind, and smoke.
- Schedule regular follow-up examinations every 6-12 months to monitor for growth or changes. Surgical intervention should be reserved for cases where the pterygium causes significant visual disturbance, induces astigmatism, restricts eye movement, or causes persistent discomfort despite conservative measures, as the risks associated with surgery, including new-onset diplopia, are significant 1. Key considerations in the management of pterygium include:
- The potential for surgical complications, such as direct injury to the adjacent medial rectus or florid scarring, which can result in consecutive exotropia or restrictive incomitant esotropia 1.
- The importance of careful patient selection and thorough discussion of the risks and benefits of surgical intervention.
- The need for regular follow-up and monitoring to ensure that the pterygium is not causing significant visual or symptomatic disturbance.
From the Research
Initial Management for Pterygium
The initial management for a patient presenting with a pterygium involves surgical excision as the main treatment 2.
Surgical Techniques
Various surgical techniques are used for the removal of pterygium, including:
- Bare Sclera
- Rotational Conjunctival Flap
- Limbal Conjunctival Autograft
- Amniotic Membrane Graft
- Free Conjunctival Autograft 2
Auxiliary Treatments
Auxiliary treatments such as:
- Mitomycin C
- B-radiation
- 5-fluorouracil
- Topical use of interferons
- Avastin are also effective in reducing the recurrence rate 2.
Role of Radiotherapy
Radiotherapy, specifically beta-irradiation, has been shown to be effective in reducing the recurrence rate of pterygium 3, 4, 5, 6.
- A study found that early postoperative beta-irradiation at a dose of 30 Gy/three fractions/2-3 weeks starting within 24h from surgical excision is an effective and safe procedure 3.
- Another study reported a local control rate of 94.6% in the first year after surgery with a dose of 2500 cGy in five fractions using a standard Sr-90 applicator 6.
- The combination of surgical excision followed by adequate Strontium-90 applications is highly effective in the management of pterygium, with an optimal total dose appearing to be in the range of 2000 cGy to 6000 cGy 5.