Pterygium Management
For symptomatic or visually significant pterygium, surgical excision combined with conjunctival autografting is the treatment of choice, with adjunctive mitomycin C (0.02% for 15 seconds) to minimize recurrence risk. 1, 2
Conservative Management
For asymptomatic or minimally symptomatic pterygium, medical management is appropriate:
- Preservative-free artificial tears (carboxymethylcellulose 0.5-1%, carmellose sodium, or hyaluronic acid) applied as frequently as needed for dry eye symptoms including burning, itching, and tearing 2
- Short-course topical corticosteroids may be used for acute inflammatory episodes, though they have limited role in long-term disease control 2
Surgical Indications
Surgery is indicated when pterygium causes: 3, 4, 5
- Loss of visual acuity
- Progressive or significant astigmatism
- Impending or actual invasion of the optical axis
- Persistent ocular surface discomfort despite medical management
- Cosmetic concerns (patient preference)
Optimal Surgical Approach
The preferred surgical technique combines excision with conjunctival autografting, as bare sclera excision alone carries unacceptably high recurrence rates. 6, 7, 5
Adjunctive Therapy to Prevent Recurrence
- Mitomycin C 0.02% (0.2 mg/ml) applied intraoperatively for 15 seconds is the standard adjunctive therapy 1
- Use mitomycin C and beta-irradiation judiciously due to potential long-term sight-threatening complications 6
Anesthetic Considerations
- Topical anesthesia is preferred over retrobulbar anesthesia to reduce the risk of postoperative diplopia 1, 8
Postoperative Management
- Topical antibiotics combined with corticosteroids should be prescribed postoperatively 2
- Preservative-free artificial tears and topical steroids for consistent postoperative care 4, 5
- Long-term UV protection is essential to prevent recurrence 4, 5
- Close monitoring for postoperative complications 2
Potential Surgical Complications
Patients should be counseled about serious but rare complications: 1, 8
- Diplopia from medial rectus damage or scarring
- Strabismus (exotropia from medial rectus damage or esotropic restrictive strabismus from scarring)
- Ocular motility problems from florid scarring associated with recurrence
- Recurrence despite optimal surgical technique
Alternative Surgical Techniques
When conjunctival autografting is not feasible, consider: 3, 7
- Amniotic membrane transplantation
- Rotational conjunctival flap
- Peripheral lamellar keratoplasty (for significant corneal ingrowth)
The key to successful pterygium management is combining optimal surgical technique (excision with conjunctival autograft), judicious use of intraoperative mitomycin C, consistent postoperative topical therapy with preservative-free medications, and lifelong UV protection. 4, 5