PTERYGIUM

PREPARED BY : FARHUDA ZULAIKHA BT DOL @ ABDUL

WAHIDDURATUL’AIN BT MOHD NAZRI

NURUL NAJUWA BT SAZALI

PTERYGIUM1) DEFINITION2) ETIOLOGY3) PATHOLOGY4) CLINICAL PICTURE (Signs & Symptoms,

course)5) DIFFERENTIAL DIAGNOSIS6) TREATMENT

1) DEFINITIONMost often refers to a benign growth of conjunctivaIt grows from the nasal side of sclerapterygium is a fleshy growth that invades the

cornea (the clear front window of the eye). It is an abnormal process in which the conjunctiva (a membrane that covers the white of the eye) grows into the cornea.

2) ETIOLOGYUnknown but may related to :

a) Ultraviolet rays (most important factor)-engaging in occupations that require outdoor activity

b) Chronic irritation by dust etcc) Genetic predisposition

-development of pterygium appear to exist in certain families

3) PATHOLOGYPterygium consists of:

- Degeneration of collagen-Fibro-vascular proliferation (fibrous tissue + blood vessels)-overlying covering of epithelium (thin layer)

4) CLINICAL PICTUREa- Signs & Symptomsb- Course

• Symptoms

Persistent redness Inflammation FB sensation

Dry eyes Itchy eyes Cosmetically disfigurement

Potential of induced

astigmatismCorneal scarring

Vision affected (if it reaches

central part of cornea)

• SignsAPEX : blunt and lies over the cornea and may grow to reach papillary area(affects vision)

NECK : Overlies the limbus

BASE : Lies over the sclera

Site : On the nasal side less commonly temporal and always bilateralShape : Is triangular and consists of apex, neck & base

• Course

A) PROGRESSIVE B) STATIONARY

Thick and fleshyVascularPreceded by white dots

Thin and membranousLess vascular

5) DIFFERENTIAL DIAGNOSISA- Neoplasia

# carcinoma in situ of conjunctiva and cornea. Also known as Bowen’s disease.# squamous cell carcinoma# other neoplastic diseases

B- Pannus

C- Pingueculae# commonly occurring, generally small and asymptomatic# occasionally be subject to some inflammation with symptoms of itching, burning, or mild pain# mild-to-moderate focal thickening of the conjunctival stroma with elastotic degeneration of collagen

pterygium

pingueculae

Difference

PTERYGIUM PSEUDO-PTERYGIUM

Nature Degenerative condition

A fold of conj, attached to the base of a healed corneal ulcer.

Site Bilateral-on nasal side

Unilateral- anywhere

Hook Cannot be passed under the neck

Can be passed under the neck

Course Progressive or stationary

Always stationary

D.D of Pterygium & PingueculaeDiff. Pterygium PingueculaeNature Degenerative condition Degenerative condition

occuring in old peopleShape Triangular which the

apex lies over the cornea Triangular nodule with base towards the cornea

Color Reddish white (fibrovascular tissue)

Yellow (raised)

Site Nasal sideAlways bilateral

Nasal side

Pathology Conjunctival epithelium (thin layer)

+Fibro-vascular tissue

+Destroyed: Bowman’s layer & sup. layer of stroma

Hyaline degeneration (of conjunctiva)

+Elastic tissue deposition

6) TREATMENTPterygium is best left alone

- if small & stationary- recurrence may follow the operation

Indications of operations :# progressive# if it encroaches pupillary area# if patient is annoyed (cosmetic reason)

NON SURGICAL1) Eyedrops for irritation and redness.2) Protection from sunlight and dust to prevent it from wosening3) Steroids to lessebn inflammations

Operation for pterygium(1)Excision + bare sclera

technique pterygium is removed

leaving a raw area of sclera (this allows corneal

epithelium to cover the cornea before conjunctival epithelium reaches the limbus)

(2)Excision + application mucous membrane,conjunctival or coeneal graft

- gap in the mucous membrane (conjunctiva) tissue, where the pterygium was removed, is filled with a transplant of tissue that has been painlessly removed from underneath the upper eyelid.

PREVENTION OF PTERYGIUMWearing protective sunglasses with side

shields and/or wide brimmed hats (as it is associated with excessive sun or wind exposure)

Using artificial tears (prevent their formation/stop further growth

Surfers & water-sport athletes:- wear eye protection (block 100% of UVR from water)

MEASURES USED TO PREVENT RECURRENCE :Expose the bare area to Beta irradiation.Expose the bare area to Mytocin CExcision & mucous membrane grat.Excixion & lamellar (structural) keratoplastyStem cell transplantation

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