Evidence Based

Pterygium (Surfer's Eye)

What Is a Pterygium (Surfer's Eye)?

A pterygium is a benign, fleshy growth that occurs on the front of your eye. The growth starts on your conjunctiva, which is the layer of tissue covering the white part of your eye. As the pterygium progresses, it can grow into the cornea, which is the transparent tissue over the front of your eye.

What Causes a Pterygium?

The exact cause for pterygium formation is unknown. However, most research points to ultraviolet (UV) radiation from the sun as the primary factor, especially if you spend a lot of time around water. The water reflects UV rays into your eyes, increasing your risk for pterygium. This is where the pterygium gets its nickname, “Surfer’s Eye.” 

Environmental exposure to dust, wind, smoke, and pollution may exacerbate this condition. Other studies suggest that genetics may also play a role in the development of pterygia.

Signs and Symptoms

A pterygium is typically slow-growing, and many people are asymptomatic when the pterygium is still small. As the pterygium grows, there are some signs and symptoms to look for:

Redness in one section of the eye. A pterygium contains many blood vessels, which is why people with pterygia notice that their eye looks red all the time. Most pterygia form in the nasal part of the conjunctiva (the side closest to the nose). Scientists believe this is because the nose tends to reflect UV rays into the nasal corner of your eye. 
Itching or burning eyes. The raised area of tissue in a pterygium causes that section of your eye to dry out more easily, causing symptoms like itching and burning. 
Foreign body sensation. A foreign body sensation is when it feels like there is something in your eye. If a pterygium becomes inflamed, the tissue swells up, increasing the chances of foreign body sensation.
Astigmatism changes. A healthy cornea allows you to maintain clear vision. Once a pterygium invades the cornea, it can distort the shape of your cornea. The corneal distortion can induce astigmatism, which may affect your quality of vision. Your eye doctor can examine your eyes to see if you have pterygium-induced astigmatism.
Blurry vision. Corneal distortion can cause blurry vision. If a pterygium grows too close to the center of your vision (over your pupil), it can obstruct your eyesight. 

Risk Factors — Is Surfer's Eye Condition Serious?

Pterygia are not cancerous and usually do not cause eye problems. However, if you suspect you have a pterygium, it is essential to have an eye exam. Your eye doctor can rule out the possibility that your growth is a type of tumor that looks similar to a pterygium. These tumors are rare but can threaten your eye health and vision.

These are some risk factors for pterygia:

  • Frequent UV exposure. People who work outdoors, such as lifeguards or landscapers, are at higher risk of pterygia. Welders may also expose themselves to significant levels of UV radiation, which is why proper eye protection is so important.
  • Living in warm climates. The sun’s rays are more intense as you get closer to the equator, so people living in these areas are more susceptible to pterygia.
  • Male gender. Studies find that pterygia are more common in men than in women. 
  • Age. Older age is associated with a higher risk of pterygia. The majority of people with this condition are over age forty.
  • Family history. There could be a genetic component involved in the development of pterygia. You may be more at risk if your family members have this condition.

Diagnosis

Your eye doctor can diagnose a pterygium by using a slit-lamp, which is a type of microscope used to examine your eyes under magnification. 

A refraction allows the doctor to check your prescription. This test helps them determine if the pterygium is affecting your vision, particularly if your astigmatism correction is changing. 

They may also take a corneal topography measurement if your pterygium is growing into your cornea. A topography is a map of the surface of your cornea and allows the eye doctor to see if the pterygium is causing corneal distortion. 

These tests help your eye doctor keep track of the size of the pterygium and how close it is to your central area of vision.

Treatment Options

Most pterygia do not require treatment. Instead, your eye doctor may recommend monitoring the pterygium yearly to track its growth. The best way to protect your pterygium is to use sunglasses with 100% UV blocking properties when outdoors. 

If you are symptomatic, there are eye drops which may provide some relief:

  • Artificial tears provide lubrication to the pterygium, as well as symptomatic relief from itching, burning, or foreign body sensation.
  • Allergy (antihistamine) eye drops also help relieve itchy eyes.
  • Anti-inflammatory eye drops can be prescribed if your pterygium becomes inflamed. 

Many people find the cosmetic appearance of a pterygium unappealing. If your eye surgeon determines the pterygium is significant enough in size or that it is affecting your vision, surgical removal is a possibility.

Can a Pterygium Return After Treatment?

If a pterygium is removed, there is always a possibility of regrowth. This is something to keep in mind if you are considering pterygium surgery. In any case, protecting your eyes from the sun is the best thing you can do to prevent further damage to your eyes.

Ninety-seven percent of all pterygium regrowths happen in the first year after surgery.

Older surgical techniques have a high rate of recurrence, at about 80%. However, newer methods may lower the recurrence rate down to 10% or less. 

Modern pterygium surgical techniques include:

  • Conjunctival autograft is a procedure that involves taking a small section from another part of your conjunctiva and using the tissue to cover the open area where the pterygium is removed.
  • Amniotic membrane graft uses tissue derived from the placental tissue of female donors after giving birth, instead of your conjunctiva. The membrane is safe and effective at preventing inflammation and scarring after eye surgery.
Author: Melody Huang, O.D. | UPDATED April 21, 2020
Resources

Caldwell, Matthew, et al. “Pterygium.” EyeWiki, American Academy of Ophthalmology, 21 Mar. 2020, https://eyewiki.aao.org/Pterygium

Iqbal, Mohammad Banyameen, et al. “Conjunctival-Corneal Intraepithelial Neoplasia: Presenting as a Pterygium.” Clinical Cancer Investigation Journal, vol. 4, no. 2, 2015, pp. 246–248., doi:10.4103/2278-0513.148918.

Lindsay, Richard G, and Laurence Sullivan. “Pterygium-Induced Corneal Astigmatism.” Clinical and Experimental Optometry, vol. 84, no. 4, July 2001, pp. 200–203., doi:10.1111/j.1444-0938.2001.tb05026.x.

Lu, Peng, and Xiao-Ming Chen. “Prevalence and Risk Factors of Pterygium.” Int J Ophthalmol, vol. 2, no. 1, 2009, pp. 82–85., http://www.ijo.cn/en_publish/2009/1/200901020.pdf

Özer, Ahmet, et al. “Long-Term Results of Bare Sclera, Limbal-Conjunctival Autograft and Amniotic Membrane Graft Techniques in Primary Pterygium Excisions.” Ophthalmologica, vol. 223, no. 4, July 2009, pp. 269–273., doi:10.1159/000210444.

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