Pinguecula Prevention Tips

Introduction

Pinguecula is a very common eye condition affecting the conjunctiva, which is a clear membrane on the eyes. The condition normally appears as a small white and yellow raised benign (non-cancerous) growth, usually on the inner side of eyes close to the nose. It is very common for pinguecula to appear in both eyes and be relatively persistent. In general, pinguecula is harmless and doesn’t affect the vision but can cause some dryness, redness and irritation to the eyes.¹ 

Pinguecula can be divided into three different grades: Grade 0 refers to no pinguecula, and grade 1 refers to the beginning of pinguecula development with mild or moderate symptoms of slightly raised yellow or white surfaces. Once the pinguecula has developed further, the disease progresses into grade 2. Grade 2 refers to severe pinguecula with a highly vascularised and elevated lesion; at this stage, surgery and medical treatment are normally required.²

It is very important to take certain precautions for the prevention of pinguecula since it may be very hard to treat once the condition develops. In addition, preventing the development of pinguecula also reduces the risk of other complications, such as pterygium and other eye diseases.³

Risk factors

PInguecula can develop after exposure to different risk factors. Some of the most common risk factors associated with the development of pinguecula are:

Excessive UV exposure

Long-term exposure to ultraviolet (UV) radiation, both from the sun and other sources, is one of the biggest causes of pinguecula as UV radiation damages the cornea; in this case, the development of pinguecula can take months or years depending on the amount of exposure to UV radiation. In general people who spend the most time outside are at a higher risk of developing pinguecula, therefore it's important to protect our eyes from the sun.¹

Dry, dusty environments

Dry and dusty environments also contribute to the development of pinguecula as dust particles may enter the eyes and cause irritation and redness, which are both key symptoms of pinguecula.¹ 

Age

In terms of age, the prevalence of pinguecula is higher among the older population; almost all individuals aged 80 have experienced pinguecula within their lifetime. Pinguecula normally affects people over the age of 40. There are no sex or racial factors contributing to the development of pinguecula in general, but males tend to be much more affected due to their occupations. ²

Contact lenses

Contact lenses have been proven to worsen pinguecula due to the constant friction and inflammation caused by lenses. Some researchers have also found that contact lens wearers are more likely to have a higher grade of pinguecula compared to those who don't wear contact lenses. Similarly, hard contact-lens wearers have a higher grade of pinguecula compared to soft contact lens wearers.²

Occupation

Certain occupations and hobbies are more likely to contribute to the development of pinguecula. For example, spending too much time in the sun leads to more exposure to UV, while working in sites filled with dirt, dust, and sand increases the risk of eye irritation.

Genetics

Some people are genetically more predisposed to certain eye conditions that can directly or indirectly play a role in the development of pinguecula.

Prevention tips

To minimise the risk of developing pinguecula, certain prevention tips can be followed. 

Wearing sunglasses

On sunny days, it is important to block the UV radiation emitted from the sun. Wearing sunglasses is one of the ways to minimise UV exposure, and some lenses, like the high index, can block both ultraviolet A and ultraviolet B radiation.²

Wearing wide-brimmed hats

Wide-brimmed hats and visors also block UV radiation effectively. It has been estimated that wide-brimmed hats can reduce the number of UV rays reaching the eyes by 30%.

Using artificial tears

Artificial tears are good for keeping the eyes moist, helping reduce dryness and stop foreign particles that may have entered the eyes.² When using artificial tears several times a day, it may be recommended to choose artificial tears that are preservative-free, as such products can be gentler on the front layers of the eyes.³

Avoiding prolonged exposure to the sun

Although sunglasses and wide-brimmed hats are great for protection against UV radiation, they may not be 100% effective all the time. Therefore, it is better to avoid prolonged exposure to the sun and seek shelter on very sunny days.

Keeping the eyes moist

Inflammation is a common symptom and cause of pinguecula. One of the ways to reduce inflammation is to keep the eyes moist by using artificial tears and, in very severe cases, the use of mild steroid eye drops.²

Quitting smoking

It is advisable to quit smoking for the prevention of pinguecula due to the high level of nicotine and other chemical reagents found in cigarettes, cigars and E-cigarettes, as these chemicals can worsen the symptoms of pinguecula.⁵

Keeping the environment clean

Keeping the environment around you clean helps prevent pinguecula as you would be less exposed to dirt and dust, which are common risk factors for pinguecula.¹

Treatment options

Depending on the stage of the pinguecula, the advised treatments will vary. In the early stages, the doctors may recommend the use of medication or artificial tears. In later stages or situations in which patients have adverse reactions to cosmetics, doctors may recommend surgery to remove the growth of pinguecula.²

In general, pinguecula can be seen by the naked eye due to its yellow and white appearance. However, before diagnosing and especially before surgery, doctors will normally examine the pinguecula using a slit-lamp microscope that allows them to visualise the growth.⁶

Medications

Common medications given for patients experiencing discomfort due to pinguecula are artificial tears, gels and ointments to keep the eyes moist. These medications lubricate the eyes and prevent redness, dryness, and inflammation; they also keep the eyes relatively clean by removing any dirt or dust particles from them. In more severe cases of inflammation, topical steroid eye drops may be prescribed for a short period of time to reduce the inflammation or swelling.¹

Surgery

Surgical excision and Argon laser photocoagulation are two relatively safe surgery procedures that can be used to remove pinguecula. 

Surgical excision is normally conducted under topical anaesthesia. The pinguecula is first excised, and then the bare sclera, the underlying white area of the eye, is closed using a conjunctival autograft. After the excision, a histological evaluation is normally conducted to ensure that the malignancy is no longer in the eyes.²

Argon laser photocoagulation uses a similar principle of removing the pinguecula but reduces the likelihood of conjunctival and complication since the process has a higher level of precision. An argon green laser is used to precisely remove the pinguecula. Depending on the thickness of pinguecula, lasers of different power are used , thicker pinguecula requires high power lasers to remove while thinner pingueculas can be removed by low power lasers. ²

After either surgery treatment, a topical antibiotic steroid eye drop that reduces the likelihood of infection is usually included in the post-operative care plan. In addition, the removal of pinguecula also tends to reduce dry eye syndrome in patients. ²

Summary

To summarise, pinguecula is a yellow or white growth that appears in the eyes after exposure to certain risk factors like UV radiation, dust and prolonged use of contact lenses. The risk of developing pinguecula increases with age, but there are some precautions that can be taken to reduce the risk by avoiding UV radiation. In the worst cases, there are still medications and surgery which can be taken to pinguecula.