Which eye specialist should I see for a pterygium?

Which Eye Specialist Should You See for a Pterygium?

You should see an ophthalmologist (MD or DO) for evaluation and management of a pterygium. While optometrists can identify pterygium during routine eye exams, definitive diagnosis, monitoring for complications, and surgical treatment require the medical training and surgical expertise of an ophthalmologist 1.

Why an Ophthalmologist is Essential

Comprehensive Medical Evaluation

• Ophthalmologists are trained to distinguish typical pterygium from atypical lesions that may represent ocular surface neoplasia, a potentially serious condition that can masquerade as benign pterygium 2.
• They can assess for vision-threatening complications including irregular astigmatism, corneal aberrations, and potential occlusion of the visual axis 3, 2.
• Medical doctors can evaluate underlying systemic conditions and prescribe appropriate medical therapies when needed 1.

Surgical Expertise When Needed

• The only definitive treatment for symptomatic or vision-threatening pterygium is surgical excision, which must be performed by an ophthalmologist 3, 4.
• Modern pterygium surgery involves complex techniques including conjunctival autografting, amniotic membrane transplantation, or peripheral lamellar keratoplasty, all requiring specialized surgical training 3, 4.
• Ophthalmologists can manage adjuvant therapies such as mitomycin C or anti-VEGF agents to prevent recurrence, which carry potential sight-threatening complications requiring careful monitoring 3, 4, 2.

When to Seek Evaluation

Early Symptoms Warranting Assessment

• Dry eye manifestations including burning, itching, or tearing even when the pterygium appears small 3.
• Any growth approaching the optical zone that could compromise visual acuity 3, 2.
• Development of astigmatism or visual distortion 2.

Red Flags Requiring Urgent Ophthalmology Referral

• Atypical appearance including irregular borders, unusual vascularity, or rapid growth that could indicate ocular surface neoplasia rather than benign pterygium 2.
• Significant corneal involvement or vision changes 3, 2.
• Recurrent pterygium after previous surgical removal, which may require more aggressive surgical approaches 3, 4.

Common Pitfalls to Avoid

• Do not delay ophthalmology referral for atypical-appearing lesions, as ocular surface neoplasia can masquerade as pterygium and requires prompt diagnosis and treatment 2.
• Do not assume all conjunctival growths are benign pterygium—ophthalmologists are trained to differentiate pterygium from other conditions including conjunctivochalasis, pinguecula, and malignant lesions 5, 2.
• Avoid seeking treatment from providers without surgical privileges, as recurrent pterygium after inadequate initial surgery becomes more aggressive and difficult to treat 3.

Role of Other Eye Care Providers

• Optometrists can identify pterygium during routine exams and provide appropriate referral to ophthalmology, but cannot perform surgical treatment 1.
• Optometrists may assist with managing dry eye symptoms and refractive changes under ophthalmology supervision 1.
• The ophthalmologist remains responsible for all medical decision-making regarding pterygium treatment, including timing of surgery and selection of surgical technique 1.