Pinguecula

Pinguecula Overview

The sun enriches your body with vitamin D, which helps strengthen your bones. However, spending long hours under the sun can affect your vision health. A common consequence is a condition known as pinguecula (plural: pingueculae).

In this article, we discuss:

• Pinguecula’s causes and symptoms
• Pinguecula duration
• Pinguecula treatment options

What is Pinguecula?

The American Academy of Ophthalmology (AAO) defines pinguecula as a yellowish raised noncancerous growth on the conjunctiva, the clear membrane covering the sclera or white of the eye.¹ You can spot the growth at the eye’s 9 and 3 o’clock sides, but it mainly occurs on the side towards the nose. 

Pinguecula results from changes in the normal eye tissue, which cause abnormal fats, proteins, or calcium deposition on the conjunctiva. 

The growth takes on a small, circular, or triangular shape. A pinguecula usually remains small and barely noticeable, but there are cases of larger growths.

Research shows pinguecula is very common, with a 22.5% to 97% prevalence rate.² The growth commonly occurs in males more than females, likely due to occupational exposures.

What are the Symptoms of Pinguecula?

The first sign of pinguecula is the yellowish-raised growth on the conjunctiva (the clear covering of the whites of the eye). 

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Someone may have more than one pinguecula in the same eye. Other symptoms to look out for include: Irritation and eye inflammation (pingueculitis), Eye redness, Blurred vision, Itching, Teary eyes, Burning sensation, Dry eyes, Eye discomfort, A sensation of having a foreign material like sand or grit in your eye

• Irritation and eye inflammation (pingueculitis)
• Eye redness
• Blurred vision
• Itching 
• Teary eyes
• Burning sensation
• Dry eyes 
• Eye discomfort
• A sensation of having a foreign material like sand or grit in your eye 

These symptoms can be mild to severe and may affect one or both eyes.

Pterygium vs. Pinguecula

Both pterygium (plural: pterygia) and pinguecula are growths that affect the conjunctiva and are caused by wind, dust, sun, and dry climate exposure.

Although considered similar, there are significant differences between the two:

A pinguecula growth contains the deposition of calcium, fats, and proteins. Pterygium (surfer’s eye) growth is made of fleshy tissue and numerous blood vessels.

Pingueculae growths remain small and do not overlap the cornea, while a pterygium grows and spreads onto the cornea affecting vision.

Pinguecula is a yellow bump. Pterygia growths come in different colors, including white, red, yellow, and gray.

Pinguecula rarely causes adverse symptoms or affects vision and doesn’t always require treatment.
Pterygium is more serious; it distorts the cornea, induces astigmatism, and interferes with the eye’s refractive power. It needs immediate medical attention.

What Causes Pinguecula?

The exact cause of pinguecula is still unclear. However, experts believe several factors cause the accumulation of fat, protein, or calcium in the eye:

• Chronic exposure to UV light from the sun: Sun exposure is the most common cause, with consequent eye irritation worsening the condition. People living along the Earth’s equator, such as in Central America and Southern Africa, are more at risk due to direct sunlight exposure throughout the year.
• Frequent exposure to dust. Eye irritation caused by dust in your eyes can cause pinguecula over time.
• Exposure to the wind. Wind may cause dry eyes and irritation that may cause pinguecula development over time.
• Aging. Older and middle-aged adults are more prone to developing pinguecula, with most people showing evidence of the condition at 80.³
• Diabetes. People with diabetes type 1 and type 2  have a higher risk of developing pinguecula. The growths manifest as conjunctival degenerations.
• Eye trauma. Injuries to your eye may affect the integrity of the conjunctiva, causing pinguecula.
• Some lysosomal storage disorders (LSDs), e.g., Gaucher disease.⁴ Linked to pinguecula that is pigmented (brown) with triangular-shaped growths. 

Does Wearing Contact Lenses Influence the Development of Pinguecula?

Contact lenses cause friction at the limbus, disrupting the tear film, which results in dry eye. Dry eye is a contributor to pinguecula.However, recent research has concluded that contact lens wearers are not at risk of developing pinguecula.⁵ Contact lenses may play a role in suppressing some symptoms.

How is Pinguecula Diagnosed?

A doctor can diagnose pinguecula during a comprehensive eye exam. The ophthalmologist will conduct a slit lamp examination to visualize the different structures of the eye. The device allows the eye doctor to see different structures of the eye by focusing a line of bright light into your eye.

How Long Does Pinguecula Last?

Pinguecula doesn’t heal on its own. Treatments only help reduce the symptoms temporarily. To permanently remove the growths, surgery is necessary. Post-surgical recovery will take at least a month, although some may take longer.  

Here are some ways to avoid the emergence, recurrence, or worsening of pinguecula:

• Wear sunglasses. Use UV-blocking glasses and sunglasses outdoors to shield your eyes from direct sunlight
• Wear a wide-brimmed hat to protect your eyes from direct sunlight
• Wear protective eyewear against the wind, dust, and other outdoor elements
• Use artificial tears and eye drops to keep your eyes moist and reduce dryness and discomfort

Pingueculae are generally harmless. Talk to your eye doctor if you have a pinguecula and continue to feel eye discomfort or notice any change in your vision despite using medications. 

Pinguecula Treatment Options

Pinguecula doesn’t always require treatment, but if the growth is causing discomfort or distorting your vision, you should see an ophthalmologist.

Early symptoms can be treated using artificial tears, steroid eye drops, or ointments over a short period. The eye drops help lubricate and reduce irritation that may worsen the condition. 

When is Surgery Needed for Pinguecula?

Surgery may be recommended in severe cases. More specifically, your ophthalmologist may recommend surgery for pinguecula in the following instances: 

• The growth is large enough and causes blurry vision
• You want the pinguecula extracted for cosmetic reasons
• The affected eye(s) remains sore and inflamed despite eye drop treatments (pingueculitis)
• If wearing contact lenses gets uncomfortable or impossible

The surgery is outpatient, meaning you’ll go home the same day. It involves the removal of the pinguecula and fixing the area with healthy conjunctiva or other eye tissue. You’ll need to wear an eye patch for a couple of days to allow for healing.

Note that a pinguecula can grow back even if you’ve had surgery. To reduce the potential recurrence, your eye doctor prescribes post-op medications like:⁶

• Antimetabolites. These may include mitomycin and 5-fluorouracil (5-FU). However, they have a high complication rate of conditions like scleral and corneal melting.
• Subconjunctival injections of anti-VEGF (bevacizumab). It is done beneath a growth to prevent pinguecula progression or recurrence and improve the outcome of conjunctival autografting.

Summary

A pinguecula is a yellowish growth made of fats, proteins, and calcium deposits on the eye’s conjunctival tissue. It presents with inflammation (pingueculitis), eye redness, swelling, and a gritty feeling in the eye.

Common causes of pinguecula include long-term exposure to the sun’s ultraviolet light, dust and wind irritation, and aging. 

You can treat pinguecula with lubricating eye drops and other over-the-counter eye ointments. However, your doctor can recommend surgery if the pinguecula interferes with vision or when you want it removed for cosmetic reasons. 

We recommend frequent eye exams to detect and treat the condition early. Talk to your doctor if you’re concerned about abnormal growths on your eye surface or if symptoms persist even after treatment.