What are the treatment options for pterygium?

Treatment Options for Pterygium

Surgical excision with conjunctival autografting is the recommended treatment for pterygium that threatens or affects the visual axis, causes significant astigmatism, or is cosmetically concerning. 1

Initial Conservative Management

For early or minimally symptomatic pterygium:

• Artificial tears and ocular lubricants - First-line therapy for mild irritation

  • Options include carboxymethylcellulose 0.5-1%, carmellose sodium, or hyaluronic acid 2
  • Lipid-containing eye drops if meibomian gland dysfunction is present 2
  • Frequency varies from once daily to several times daily based on symptom severity

• Topical anti-inflammatory medications

  • Indomethacin 0.1% for inflamed pterygium 1
  • Short courses of topical corticosteroids for acute inflammation
  • Avoid long-term steroid use due to risk of cataract and intraocular pressure elevation

• UV protection

  • Sunglasses and hats to reduce UV exposure
  • Critical for preventing progression and recurrence after treatment 3

Surgical Management

Surgery is indicated when pterygium:

1. Threatens or encroaches on the visual axis
2. Causes significant astigmatism affecting vision
3. Presents significant cosmetic concerns
4. Causes persistent irritation unresponsive to conservative treatment

Preferred Surgical Techniques:

1. Excision with conjunctival autografting - Gold standard approach 1, 4

   • Involves complete removal of pterygium followed by transplantation of patient's own conjunctival tissue
   • Lowest recurrence rates (5-10%) compared to other techniques
   • Better cosmetic outcomes and fewer complications

2. Adjunctive therapies to reduce recurrence:

   • Mitomycin C - Applied intraoperatively (0.02-0.04% for 1-3 minutes) 5

     • Caution: Risk of delayed epithelial healing, scleral thinning, and corneal perforation
     • Should be used judiciously due to potential long-term sight-threatening complications 4

   • 5-Fluorouracil - Topical application during or after surgery 1, 5

   • Anti-VEGF agents - May reduce recurrence by inhibiting neovascularization 3

     • Emerging evidence supports their use as adjunctive therapy

3. Alternative surgical approaches:

   • Amniotic membrane grafting - Useful in cases with extensive conjunctival involvement 5
   • Rotational conjunctival flap - Alternative when autograft tissue is limited 5
   • Peripheral lamellar keratoplasty - For significant corneal involvement 6

Post-Surgical Management

• Topical antibiotics for 1-2 weeks
• Topical corticosteroids for 4-6 weeks with gradual taper
• Regular follow-up to monitor for recurrence
• Long-term UV protection with sunglasses to prevent recurrence 3
• Preservative-free lubricants for ocular surface comfort

Recurrent Pterygium

For recurrent pterygium, more aggressive management is needed:

• Repeat excision with conjunctival autograft
• Consider adjunctive mitomycin C if not used in primary surgery
• Anti-VEGF agents may be beneficial in reducing recurrence rates
• More extensive conjunctival grafting may be necessary

Complications to Monitor

• Recurrence - Most common complication, rates vary by technique 1
• Graft failure or retraction
• Diplopia due to scarring or injury to medial rectus 1
• Corneal scarring and astigmatism
• Scleral thinning (especially with mitomycin C)
• Dry eye symptoms

The treatment approach should be based on the size, location, and progression of the pterygium, with surgical intervention reserved for cases that affect vision or cause persistent symptoms despite conservative management. Conjunctival autografting remains the most effective surgical technique with the lowest recurrence rates.