What is a Pinguecula?
A pinguecula is a benign, yellowish, elevated conjunctival lesion that occurs on the bulbar conjunctiva adjacent to the limbus but does NOT cross onto the cornea, distinguishing it from its related condition, pterygium.
Key Distinguishing Features from Pterygium
The critical difference is that pinguecula remains confined to the conjunctiva, while pterygium is a fibrovascular growth that crosses the limbus and extends onto the cornea. 1, 2
Pterygium Characteristics (for comparison):
- Triangular conjunctivo-epithelial overgrowth that proliferates from the bulbar conjunctiva and invades the corneal surface 3
- Crosses the limbus and extends onto the peripheral cornea, potentially reaching the optical zone 1, 4
- Can cause significant visual complications including corneal astigmatism and vision impairment 1, 2
Shared Etiology
Both pinguecula and pterygium share similar risk factors:
- Chronic ultraviolet (UV) radiation exposure is the primary pathogenic factor 1, 2, 4
- Environmental irritants including heat and dust 3
- Potential viral infection involvement 2, 3
- Tear film abnormalities and immunologic disturbances 2
Clinical Significance
Pinguecula:
- Typically asymptomatic and cosmetic in nature
- May cause mild irritation or dry eye symptoms
- Does not require surgical intervention unless symptomatic
Pterygium (when it progresses):
- Initially asymptomatic but can develop dry eye manifestations (burning, itching, tearing) 2
- Surgical treatment is indicated when: visual acuity is compromised, progressive astigmatism develops, the lesion approaches the optical axis, or significant ocular surface discomfort occurs 5, 4
- Can cause diplopia or strabismus as a surgical complication due to medial rectus damage or scarring 6, 7
Prevention
Long-term UV protection is essential for both conditions to prevent development and progression 5, 4