What is the treatment for pinguecula?

Treatment of Pinguecula

For symptomatic pinguecula with inflammation, topical indomethacin 0.1% solution is the preferred first-line treatment, administered 4-6 times daily for 2 weeks, as it provides equivalent efficacy to corticosteroids without the risk of rebound inflammation upon discontinuation. 1, 2

Conservative Management Approach

Asymptomatic Pinguecula

• No treatment is necessary for asymptomatic pinguecula, as these are benign lesions that do not affect vision 3
• Observation alone is appropriate when patients have no complaints of irritation, redness, or cosmetic concerns 3

Symptomatic Pinguecula - First-Line Therapy

Topical NSAIDs are the treatment of choice:

• Indomethacin 0.1% solution should be administered 6 times daily for 3 days, then reduced to 4 times daily for 11 additional days 1
• This regimen significantly reduces both objective signs (conjunctival congestion, redness, edema) and subjective symptoms (photophobia, pain, foreign body sensation, tearing) within 3 days 1
• Improvement continues progressively through day 14 of treatment 1
• Patients should expect mild stinging lasting less than 1 minute after drop administration 1

Alternative Anti-Inflammatory Options

If indomethacin is unavailable or not tolerated:

• Dexamethasone phosphate 0.1% solution can be used with the same dosing schedule (6 times daily for 3 days, then 4 times daily for 11 days) 2
• However, corticosteroids carry a significant disadvantage: rebound inflammation occurs after discontinuation, with recurrence of signs being significantly greater at 2-4 weeks post-treatment compared to indomethacin 2
• Preservative-free formulations should be prioritized when using topical corticosteroids to minimize additional conjunctival irritation 4

Adjunctive Symptomatic Relief

• Preservative-free artificial tears can be used for minor irritation and dryness symptoms 3
• These provide lubrication but do not address the underlying inflammation 3

Novel Experimental Therapies

• Topical dipyridamole in normal saline solution has shown promise in a single case report, with regression of tissue and resolution of symptoms over 12 months 5
• However, this remains investigational and requires further study before routine clinical use 5

Important Clinical Pitfalls

Avoid these common errors:

• Do not confuse pinguecula with pterygium - pinguecula does not cross the limbus onto the cornea, while pterygium does 6, 3
• Do not rush to surgery - pinguecula rarely requires surgical intervention, unlike pterygium which may affect the visual axis 3
• Do not use corticosteroids as first-line therapy - while effective, they cause more rebound inflammation than NSAIDs after discontinuation 2
• Do not ignore persistent symptoms - if inflammation does not respond to 2 weeks of topical NSAIDs, reassess the diagnosis to exclude other conditions 1

When to Refer

• Ophthalmology referral is appropriate if symptoms persist despite appropriate medical therapy for 2-4 weeks 1
• Surgical excision is rarely indicated for pinguecula and should only be considered for severe cosmetic concerns or persistent symptoms refractory to all medical management 3