A pterygium is a fibrovascular growth arising from the conjunctiva that gradually encroaches onto the cornea, usually from the side nearest the nose, appearing as a triangular fleshy membrane crossed by blood vessels. Its strongest associations are chronic ultraviolet exposure, dust, wind, and surface dryness, which is why it is common in Jordan's climate and among people who work outdoors. Symptoms vary. Many people complain only about appearance and recurrent redness, while others have a foreign-body sensation, burning, watering, and irritation that worsens with sun and dust. As it advances across the cornea it can induce astigmatism that blurs vision, and in advanced cases it approaches the visual axis or restricts eye movement. An important correction: a pterygium is not a cataract and is not usually a cancer. Many patients confuse it with cataract because both are described as a white film. On the other hand, it is not automatically benign on appearance alone; a rapidly growing, atypical, pigmented, or ulcerated lesion needs careful assessment and may be sent for histological examination after excision. Management follows severity. In mild cases observation is enough, with artificial tears, sunglasses that block ultraviolet light, and avoidance of dust, and a short supervised course of anti-inflammatory drops is sometimes used. Surgery is indicated when the pterygium encroaches towards the visual axis, induces significant astigmatism, causes recurrent irritation that will not settle, restricts eye movement, prevents contact-lens wear, or when its appearance is a genuine concern. The technique used today is excision with coverage of the bare area by a conjunctival autograft secured with biological glue or fine sutures, because leaving the area bare is associated with a much higher recurrence rate. The limits must be stated clearly. Surgery removes the pterygium but does not eliminate the possibility of recurrence, and recurrence is higher in younger patients, after bare-sclera excision, and when sun exposure continues without protection. Excision also does not always correct all the astigmatism that has developed, nor remove residual corneal haze when the pterygium was long-standing and deep. Drops do not reverse or dissolve a pterygium; they only ease symptoms, and prolonged unsupervised steroid use risks raised eye pressure and cataract.
Procedure steps
- 1
Examination and documenting the extent
The pterygium is examined at the slit lamp and its encroachment onto the cornea is measured, visual acuity, cornea, ocular surface, and lids are assessed, and the eye is photographed for comparison. Corneal imaging may be added to quantify induced astigmatism and document the effect on vision.
- 2
Deciding between observation and surgery
Symptoms, extent, and the effect on vision are weighed against the risks of surgery and the possibility of recurrence, and it is explained that appearance alone is an acceptable reason for surgery when it genuinely affects the patient, provided expectations remain realistic.
- 3
Local anaesthesia and excision
The eye is anaesthetised with drops and a local injection, the pterygium is separated from the cornea and conjunctiva and its fibrous tissue is carefully excised, the corneal surface is smoothed, and bleeding vessels are controlled gently while avoiding excessive heat.
- 4
Covering the area with a conjunctival autograft
A thin graft is taken from the patient's own conjunctiva beneath the upper lid and secured over the excision site with biological glue or fine sutures, since this step is the most important factor in reducing recurrence compared with leaving the area bare.
- 5
Drops and follow-up for recurrence
Anti-inflammatory and antibiotic drops are prescribed for a defined period and tapered, and the patient is reviewed the next day, then weekly at first and at longer intervals for months, because recurrence, when it happens, usually occurs in the first months.
Before the procedure
Tell your doctor about all your medications, especially blood thinners and aspirin, and do not stop any of them yourself; this should be arranged between your eye surgeon and your treating physician. Mention chronic conditions such as diabetes, hypertension, and any immune disease, allergies to any drug or material, and any previous eye surgery or a pterygium removed before, since recurrence changes the plan. Stop contact lenses for the period your doctor specifies. Do not wear eye make-up or false lashes on the day, come with a clean face, and arrange transport both ways because the eye will be padded and your vision uncomfortable. Ask about fasting if sedation is planned. At home, have your prescribed drops, UV-blocking sunglasses, and clean gauze ready, and plan time off work suited to your job, especially if you work in dust, outdoors, or in front of ovens and heat.
After the procedure
Expect a scratchy, burning sensation, watering, redness, and swelling of the graft for one to two weeks, and you may see sutures or the graft edge; this is a normal course. Use your drops exactly on schedule, and neither stop the anti-inflammatory drop yourself nor extend it on your own, since both cause harm. Do not rub or press on the eye, sleep on the unoperated side for the first nights, and wear the protective shield if you were given one. Avoid swimming, steam rooms, dust, outdoor work, and heavy lifting for the period your surgeon specifies. Wear UV-blocking sunglasses long term afterwards, as this is the best way to reduce recurrence, and continue artificial tears if the surface feels dry. Do not expect the redness to disappear quickly; it can take months to settle. **Seek care immediately for severe or increasing pain, reduced vision, green or yellow purulent discharge, persistent bleeding, a graft that shifts or detaches, marked light sensitivity, or new fleshy tissue creeping onto the cornea.**
Expected duration
Surgery usually takes 20 to 40 minutes under local anaesthesia with same-day discharge, and return to office work is typically after a few days to a week as advised.
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