What Is a Pterygium (Surfer's Eye)?
A pterygium (pronounced tr·i'·jee·uhm) is an abnormal fleshy growth on the white part of your eye.
Also called surfer's eye, it is a benign and non-cancerous mass.
It initially forms on the dark ring (limbus) around your iris. As it progresses, it can grow into the cornea or the clear layer protecting the surface of your eye.
Eventually, it can cover your pupil and impair your central vision.
Surfer's eye isn't usually serious. But it can lead to vision problems and make it difficult to see shapes, colors, and details.
Thankfully, it is a treatable and preventable eye condition.
What Causes Pterygium or Surfer's Eye?
Doctors do not know its exact cause. However, researchers have identified factors that increase your risk.1,2
Risk factors for pterygium include:
- Family history of pterygium
- High exposure to ultraviolet light
- Tropical or subtropical climate
- Living in a rural area
- Spending a lot of time outdoors
- Environmental irritants (e.g., dust and wind)
- Dark skin complexion
- Smoking
Pterygium is common in adults. According to studies, people ages 20 to 40 have the highest rates of pterygium. Meanwhile, pterygia usually occur in those adults 40 years.2
Men are also twice more likely to develop pterygium. Though it may be because men are frequently exposed to sunlight.1
Surfer's eye is 10 times more prevalent in places near the equator. Scientists believe it is caused by the high levels of UV rays in these areas.1,2
Signs and Symptoms of Pterygium
In most cases, a pterygium forms on the side of your eye that is near your nose (nasal). But it can develop on the side near your ears (temporal).1
Symptoms may affect one eye (unilateral) or both eyes (bilateral pterygium). You can also have a single growth (pterygium) or multiple growths at a time (pterygia).
Surfer's eye progresses slowly in some people, while others may notice a sudden growth without experiencing any symptoms.
Here are some common signs that you have surfer's eye:
1. Feels like something is in your eye
One early sign of pterygium is having a strange feeling that something is in your eye. Even if you rub your eye or try to wash it, the feeling will not go away.
2. Pinguecula
Some people may develop a pinguecula (pronounced ping·geh'·kyuh·luh) before a pterygium. It is a yellowish-white bump that grows beside the cornea.
What makes it different from surfer's eye is that it consists of protein, fat, or calcium — hence, its creamy color.
3. Flesh-like growth
A pterygium looks like fleshy tissue on the white part of your eye. You will normally find it at a 3 or 9 o'clock angle.3
It will continue to grow outwards and form into a triangular, wing-shaped mass adjacent to the cornea. Although it stops growing at some point.
4. Itchy or burning eyes
Pterygium prevents tears from evenly lubricating your eye. This can make your eyes feel dry and gritty, especially when exposed to irritants like dust, sand, and wind.
In turn, dry eyes can lead to itching and burning.
5. Redness of the affected area
When your eyes are constantly irritated, it can become red and inflammed. Surfer's eye also contains blood vessels. So it may seem red even though it isn't irritated.
6. Changes in vision
In severe cases, a pterygium can grow over the pupil and change the shape of the cornea. This can lead to blurry or double vision.
A pterygium can also worsen your astigmatism, myopia (nearsightedness), or hyperopia (farsightedness).
How is Pterygium Diagnosed?
A doctor can diagnose surfer's eye through physical examination. They might also ask questions to identify possible causes.
An eye exam can help them confirm your diagnosis and check for complications. Here are the exams:
Slit-lamp exam
A slit lamp is a microscope with light. Doctors use it to inspect structures inside and outside your eye.
They can have a closer look at the growing mass and confirm if it really is a pterygium. A slit lamp exam can also help them assess if the growth has spread to the cornea.
Refraction test
A refraction test is normally used to check visual acuity. If you have a surfer's eye, they can use it to determine vision changes.
Corneal topography
The imaging test allows an ophthalmologist to visualize the shape of your cornea. It can help them find out how a pterygium is affecting your eyesight.
How is Pterygium or Surfer's Eye Treated?
Surgery remains to be the mainstay of pterygium treatment. Namely, they use the bare sclera technique or the surgical removal of the mass.4
Doctors usually recommend surgery if:
- The growth spreads too fast
- It affects your eyesight
- Your symptoms cause regular discomfort
- Its appearance bothers you
However, pterygium surgery is not always required. If the mass grows slowly or if you have mild symptoms, doctors may suggest alternative ways to manage them.
Managing your pterygium symptoms
An eye doctor may prescribe the following to help you manage surfer's eye:
- Artificial tears. Lubricating eye drops moisten the pterygium and relieve itching and burning. It also lessens the feeling that something is in your eye.
- Corticoid steroid eye drops. Doctors may prescribe steroid eye drops to reduce inflammation and irritation.
Does Pterygium Return After Surgery?
It doesn't always happen. But pterygium recurrence is possible.
Studies show it recurs in 24 to 89% of people who undergo bare sclera surgery. People below 50 also have a higher risk for pterygium recurrence.4,5
That said, the following methods can reduce your risk and prevent scar tissue formation:4
- Conjunctival autograft. After removing the pterygium, healthy conjunctival tissue is placed over the sclera and allowed to regrow. It reduces recurrence to about 2 to 40%.
- Amniotic membrane grafting. Amniotic tissue is placed on the bare sclera after surgically removing the pterygium. It has a recurrence rate of 2.6 to 10.7% in people who never had pterygium and 37.5% in people who previously had it.
- Mitomycin C (MMC) eye drops. When used during and after surgery, it can lower your risk for pterygium recurrence.
Can I prevent surfer's eye?
Yes. Pterygium is a preventable eye condition. Below are some tips to prevent it:
- Wear sunglasses that can block up to 99% of ultraviolet rays, including UVA and UVB
- Use wraparound sunglasses so you can also protect your eyes from wind, dust, and sand
- If you can't wear sunglasses, wear a wide-brimmed hat for eye protection against ultraviolet light
- Have your car windows coated with a tint that blocks UV
- When the climate is too hot or dry, keep your eyes moisturized with artificial tears
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