From the Guidelines
Yes, a pterygium should be referred to an ophthalmologist for evaluation and management. A pterygium is a benign growth of conjunctival tissue that extends onto the cornea, typically on the nasal side. While not all pterygia require immediate treatment, an ophthalmologist should assess the condition to determine its severity and appropriate management. Referral is particularly important if the pterygium is growing rapidly, causing discomfort, affecting vision, or cosmetically concerning to the patient. The ophthalmologist may recommend conservative management with lubricating eye drops, preservative-free artificial tears, or mild steroid drops for inflammation. For more advanced cases causing visual disturbance or significant discomfort, surgical removal may be necessary. Surgery is the only definitive treatment for pterygium, but recurrence is possible. Early evaluation is beneficial as the ophthalmologist can monitor progression over time and intervene before the pterygium encroaches on the visual axis. Additionally, the specialist can rule out other ocular surface conditions that might mimic pterygium appearance.
Key Considerations
- The ophthalmologist should discuss and explain the findings and discuss management options with the patient, as indicated by 1.
- Referral to an ophthalmologist is crucial for determining the severity of the pterygium and appropriate management, especially if the condition is causing visual disturbance or significant discomfort.
- The ophthalmologist can provide education on the condition, its management, and the potential risks and benefits of treatment, as emphasized in 1 and 1.
- Early evaluation and management can improve outcomes and reduce the risk of complications, such as visual impairment or recurrence of the pterygium.
Management Options
- Conservative management with lubricating eye drops, preservative-free artificial tears, or mild steroid drops for inflammation may be recommended for mild cases.
- Surgical removal may be necessary for more advanced cases causing visual disturbance or significant discomfort.
- The ophthalmologist can monitor progression over time and intervene before the pterygium encroaches on the visual axis, as suggested by 1.
From the Research
Pterygium Referral to Ophthalmologist
- A pterygium is a bulbar conjunctival fibrovascular growth that can lead to significant visual complications, including eye irritation, corneal astigmatism, and damage to the visual axis leading to vision impairment 2.
- The treatment of pterygium has been developed, and various new solutions have been used, with surgery being the main treatment 2, 3, 4.
- Surgical techniques such as conjunctival autograft, amniotic membrane graft, and bare sclera excision are used to remove the pterygium, with conjunctival autograft being associated with a lower risk of recurrence at six months after surgery compared to amniotic membrane transplant 5.
- Adjunctive therapies such as mitomycin C, beta-irradiation, and interferons are also used to reduce recurrence rates, but their use should be judicious due to the potential long-term risk of sight-threatening complications 3, 6.
- Given the potential for significant visual complications and the various treatment options available, it is recommended that a pterygium be referred to an ophthalmologist for evaluation and treatment 2, 3, 4, 5, 6.
Key Considerations
- The risk of recurrence is a dominant complication of pterygium excision, regardless of the adopted surgical procedure 4.
- Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences 6.
- The use of adjunctive therapies should be carefully considered due to the potential long-term risks of sight-threatening complications 3, 6.
- Further research is needed to evaluate the relative efficacies and long-term safety of the various treatment modalities 6.