Medical Management of Pterygium

May 12, 2023
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How I think about medical (non-surgical) management of pterygium

In my last blog post, I spoke about the basic pathophysiology (or clinical development) or a pterygium. Now I'd like to explain how I typically manage these medically. 

This is not medical advice, so please consult with a physician prior to starting any treatment. 

First, if the pterygium is small and asymptomatic, we can leave it alone and observe it for awhile. As an ophthalmologist, I will typically measure the size of the pterygium, so that I can compare it in size to the prior visit, to see if it is growing or not.

Sometimes I will also order a corneal imaging test called "topography" or "tomography" to determine how the pterygium is affecting the astigmatism on the cornea. Typically, the pterygium causes "flattening" of the cornea in an asymmetric, "triangle" or "wing"-shaped pattern. This is actually where the pterygium gets its name: "ptéryga" is Greek for "wing".  

If the pterygium is small but bothersome to the patient, I will start to recommend some treatments. First, I typically recommend ocular lubrication with artificial tears. The rationale is that pterygium can adversely affect the tear film distribution over the ocular surface, and cause the eye to dry out and become irritated. The hot sun, wind and sand can make this worse, hence the nickname of "surfer's eye". Of course, this is a good time to also double down on the sunglasses with UV protection as well as wide brim hats. 

When artificial tears are not enough and the pterygium is still inflamed, we will sometimes add a short course of topical steroid. This should only be done under the supervision of a physician, because the steroids can have some side effects if not utilized properly. 

Other modalities to treat dry eye can also help pterygium irritation, such as treatment with anti-inflammatory dry eye medications, warm compresses, and eyelid hygiene. 

If the pterygium continues to be bothersome and is starting to encroach more centrally onto the cornea (the clear tissue at the front of the eye), it is time to start thinking about surgical management. 

I will cover this in a different blog post. 

Until next time,