Introduction  

Pterygium excision is a surgical technique used to remove non-cancerous conjunctiva tissue (pterygia) from the surface of the eye. The pterygiums can become red and irritated, and eventually affect vision.

In many cases, pterygium has little to no symptoms. If the pterygium is small but occasionally becomes inflamed, the ophthalmologist can recommend the application of eye drops (nonsteroidal or mild steroid) when the inflammation occurs. Surgical removal of the growths may be recommended where the tissue causes chronic irritation and inflammation, interferes with contact lens wear, or grows far enough to impair vision. The pterygium may also be removed for cosmetic reasons.
 

Also Known As

  • Pterygium surgery
  • Pterygium excision surgery

 

Preparation & Expectation Before Surgery

Pterygium surgery is an outpatient procedure that takes about 30 to 45 minutes. The surgeon and the patient will discuss the operation, and s/he will provide general preparation guidelines. The patient may be required to eat only a light meal or fast before the procedure. Patients who wear contact lenses may be instructed not to wear them for at least 24 hours. The patient should be accompanied with someone or make arrangements to be taken home after the procedure because they will be lightly sedated.
 

Types, Purpose & Procedure

Pterygium surgery is a minimally invasive, quick, and low-risk procedure that is performed using anesthetic eye drops. The surgeon sedates and numbs the patient’s eyes to prevent discomfort and cleans the surrounding areas. S/he removes the pterygium and related conjunctiva tissue and replaces it with an associated membrane tissue graft. The graft can prevent recurrent pterygium growths.

The surgeon can use fibrin glue or dissolvable sutures to secure the conjunctiva tissue graft in its place to reduce the chances of recurrent pterygia. Fibrin glue reduces discomfort and inflammation and cuts the recovery time. However, it’s more expensive than sutures and may carry the risk of transmitting diseases and viral infections because it’s a blood-derived product. Dissolvable stitches are considered the benchmark practice but can extend the recovery time for several weeks and cause more discomfort after the surgery.

The more traditional approach is known as the bare sclera technique. It involves removing the pterygium tissue and leaving the underlying eye white exposed to heal independently without a tissue graft. It may eliminate the issues associated with dissolvable sutures or fibrin glue, but it has a high pterygium regrowth rate, and at a bigger size.

After the surgery, the surgeon can apply an eye pad or patch to prevent infection and comfort.
 

Risks, Side Effects & Complications

In sporadic cases, the patient may experience:

  • Infection
  • Inflammation
  • Recurrence of the pterygium
     

It’s normal to experience some discomfort, foreign body sensation and blurriness for about a week after the procedure. The surgical site will also have redness which can last up to six weeks.

In rare cases, the patient may experience some complications such as:

  • Double vision
  • Prolonged redness
  • Dislodged graft tissue
     

The patient should see the ophthalmologist if they experience vision challenges, a complete vision loss, or notice pterygium regrowth. Pterygium recurrence occurs in about 12 percent of the cases within the first two years after the surgery. The surgeon may apply medications to the eye surface in an additional procedure to lower the risk of recurrence.
 

After Care, Recovery & Results

The surgeon will prescribe steroid eye drops to minimize the chances of recurrence. The medication must be applied to the eye surface daily for two months. 

S/he will also prescribe antibiotic eye drops to prevent infection. They must be used for one week following the surgery. It’s critical to comply with the dosing schedule to avoid recurrent pterygium. It’s  also important to avoid rubbing the eyes after the surgery to prevent dislodging the graft tissue.

The surgeon will check the patient the day after the procedure surgery. S/he will follow-up at an interval of one week, one month, three months, six months and twelve months. After that, the patient should visit the doctor annually for pterygium recurrence checks.

Recovery time can range from a few weeks to about two months, depending on the surgical technique. The surgeon will provide aftercare instructions, including antibiotics, cleaning methods and a follow-up visits schedule.

Generally, pterygium surgery has good outcomes, particularly when the patient complies with the prescription eye drop schedule.