What are the recommended eye drops for managing pterygium?

Recommended Eye Drops for Managing Pterygium

Preservative-free hyaluronate eye drops are the first-line treatment for managing pterygium, providing essential lubrication to reduce irritation and protect the ocular surface. 1, 2

First-Line Treatment Options

• Preservative-free hyaluronate drops are recommended as the primary treatment for pterygium, typically applied 2-4 times daily to maintain adequate lubrication of the ocular surface 1
• Carboxymethylcellulose 0.5-1% or carmellose sodium can be used as alternative lubricants when hyaluronate drops are not available 1
• For nocturnal symptoms, petrolatum ointment can be applied at night to provide extended protection 1
• Lipid-containing eye drops are particularly beneficial when there is concurrent meibomian gland dysfunction 1

Treatment Algorithm Based on Severity

Mild Pterygium

• Begin with preservative-free hyaluronate drops 2-4 times daily 1
• Frequency may need to be increased up to half-hourly in more symptomatic cases 1
• Higher percentage hyaluronate formulations offer greater therapeutic efficacy and should be used in more severe disease 1

Moderate to Severe Pterygium

• Continue preservative-free lubricants as baseline therapy 1
• Add topical corticosteroid eye drops for short-term management of inflammation (maximum 8 weeks) 1
• Loteprednol etabonate ophthalmic suspension may be used, one drop four times daily 3
• Monitor intraocular pressure if corticosteroid eye drops are used for more than 10 days 3

Special Considerations

• Patients with ectropion should receive more frequent ocular lubricants as first-line treatment 1
• Eyelid emollients and massage (vertical lid massage and stretching) can improve associated lagophthalmos and ectropion 1
• For patients with significant inflammation, short-term topical corticosteroids may be beneficial, with a 74% response rate reported in ocular surface disorders 1

Surgical Management Considerations

• When pterygium causes visual disturbance, astigmatism, or approaches the visual axis, surgical intervention should be considered 4, 5
• Post-surgical management includes:
  • Topical steroids to reduce inflammation 6
  • Preservative-free lubricants to promote healing and comfort 6
  • Long-term UV protection to prevent recurrence 6

Important Precautions

• Avoid preservative-containing eye drops for long-term use as they may cause irritation and allergic contact dermatitis 1
• If using corticosteroid eye drops, limit duration to avoid complications such as increased intraocular pressure and potential fungal infections 3
• Regular ophthalmological follow-up is essential to monitor disease progression and treatment response 1
• If symptoms worsen despite treatment, prompt ophthalmological reassessment is necessary 3

Treatment Efficacy

• Ocular lubricants have shown a 65% good or very good response rate in managing ocular surface disorders 1
• Topical corticosteroids demonstrate a 74% response rate but should be used judiciously due to potential side effects 1
• Antihistamine eye drops show limited efficacy (42% response rate) and should be considered only as adjunctive therapy 1