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Pterygium

Article initiated by: Matthew Caldwell

All authors and Lawrie Hirst, Vatinee Y. Bunya, MD, MSCE, Maria A. Woodward, MD, Nambi Nallasamy, MD, Erica Bernfeld M.D., Bharat Gurnani MBBS,DNB,FCRS,FICO(UK),
contributors: MRCS (Ed), MNAMS, Matthew Caldwell, Masako Chen, MD, Aaron R. Kaufman, MD

Assigned editor: Masako Chen, MD

Review: Assigned status Update Pending

 by Masako Chen, MD on April 17, 2022.

Pterygium
Contents [hide]

1 Disease Entity
1.1 Etiology
1.2 Risk Factors
1.3 General Pathology
1.4 Pathophysiology
1.5 Primary prevention
2 Diagnosis
2.1 Physical examination
2.2 Signs
2.3 Symptoms
2.4 Clinical diagnosis
Pterygium
2.5 Diagnostic procedures
2.6 Differential diagnosis
DiseasesDB 10916
3 Management
3.1 General treatment ICD-10 H11.0
3.2 Medical therapy
MedlinePlus 001011
3.3 Medical follow up
3.4 Surgery MeSH D011625
3.5 Surgical follow up
3.6 Complications
3.7 Prognosis
4 Additional Resources
5 References

Disease Entity
Pterygium, from the Greek pterygos meaning “wing”, is a common ocular surface lesion originating in the limbal conjunctiva within the palpebral fissure with progressive involvement of the cornea.
The lesion occurs more frequently at the nasal limbus than the temporal with a characteristic wing-like appearance.

Etiology
The pathogenesis of pterygia is highly correlated with UV exposure. An increased incidence is noted in latitudes nearer the equator and in individuals with a history of increased UV exposure
(outdoor work). Some studies have shown a slightly higher incidence in males than females, which may only reflect a higher rate of UV radiation.

Risk Factors
UV radiation, proximity to the equator, dry climates, outdoor lifestyle[1].

General Pathology
Histologically, pterygia are an accumulation of degenerated subepithelial tissue which is basophilic with a characteristic slate gray appearance on H&E staining. Vermiform or elastotic degeneration
refers to the wavy worm-like appearance of the fibers. Destruction of Bowman layer by fibrovascular ingrowth is typical. The overlying epithelium is usually normal, but may be acanthotic,
hyperkeratotic, or even dysplastic and often exhibits areas of goblet cell hyperplasia.

The American Academy of Ophthalmology's Pathology Atlas contains two virtual microscopy images of tissue samples with Pterygium[2]:

Pterygium – 1
Pterygium – 2

Pathophysiology
The large number of theories that exist to explain the pathogenesis of pterygium growth underscores the uncertainty of the etiology. The
increased prevalence in hot dry climates and regions nearer to the equator suggest a role of environmental factors such as UV radiation and
dryness. Actinic changes seen on histopathology similar to actinic keratoses on the skin also supports the role of UV radiation. It has been
suggested that radiation activated fibroblasts may result in excessive production of material resulting in pterygia. Other proposed theories
include choline deficiency, inflammation, disregulation of angiogenesis, immune system abnormalities, tear film abnormalities, as well as the
possible role of a viral stimulus.

Coronea MT proposed that pterygium occur due to albedo concentration in the anterior eye (albedo's hypothesis). Light entering the
temporal limbus at 90 degree is concentrated at medial limbus and this is responsible for predominance of medial pterygia.[3]

Primary prevention Pterygium histopathology. H&E stain exhibiting

elastotic degeneration.
As UV radiation is believed to play an important role in the pathophysiology, avoidance of UV exposure is important to primary prevention.
Ocular surface lubrication may also help.

Diagnosis

Management

Additional Resources

References

Categories: Articles Cornea/External Disease

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This page was last edited on August 8, 2022, at 10:31. This page has been accessed 194,244 times.

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