Referral for Pterygium Surgery
Patients with surgically indicated pterygium should be referred to a corneal specialist or comprehensive ophthalmologist with expertise in anterior segment surgery who routinely performs pterygium excision with conjunctival autograft. 1
Appropriate Specialist Qualifications
The ophthalmologist performing pterygium surgery should meet the following criteria:
- Board-certified ophthalmologist with adequate training, experience, and competence in anterior segment microsurgical techniques 1
- Specific expertise in conjunctival autografting procedures, as this technique requires microsurgical skills and proper execution to minimize recurrence 2, 3
- Access to appropriate surgical facilities and equipment for microsurgical procedures 1
- Ability to provide adequate pre- and postoperative care with appropriate follow-up mechanisms 1
Why Specialist Referral Matters
Pterygium excision with conjunctival autograft is technically demanding and requires microsurgical expertise. The procedure involves:
- Precise dissection and complete removal of pterygium tissue from the corneal surface 2
- Harvesting healthy conjunctival tissue from the superior bulbar conjunctiva 3
- Meticulous placement and fixation of the autograft (with sutures or fibrin glue) 3
- Management of potential complications including graft displacement, granuloma formation, or recurrence 3
The relatively long surgical time and microsurgical methods required have made this a specialized procedure that should not be performed by surgeons without adequate experience. 4
Surgical Outcomes and Recurrence Prevention
Conjunctival autografting is one of the most effective methods for preventing pterygium recurrence, with reported recurrence rates as low as 4.4-7.7% in experienced hands. 3, 4 This compares favorably to:
- Bare sclera excision alone: 30-89% recurrence rate 5
- Mitomycin C application: comparable efficacy but with potential sight-threatening complications requiring judicious use 2, 5
- Beta-irradiation: comparable efficacy but with long-term safety concerns 2, 5
Timing of Referral
Refer promptly when pterygium causes:
- Visual impairment from induced astigmatism or encroachment on the visual axis 6
- Significant ocular surface irritation or dry eye symptoms not controlled with conservative measures 6
- Cosmetic concerns affecting quality of life 6
- Progressive growth toward the pupillary axis 2
Common Pitfalls to Avoid
Do not delay referral until the pterygium has extensively invaded the cornea, as more advanced lesions have higher recurrence rates and more complex surgical management. 2
Avoid referring to surgeons who primarily use bare sclera excision without adjunctive therapy, as this approach has unacceptably high recurrence rates of 30-89%. 5
Do not assume all ophthalmologists perform pterygium surgery with equal expertise—the microsurgical nature of conjunctival autografting requires specific training and experience. 4