Introduction
Pinguecula and pterygium are two common conditions affecting the conjunctiva (the clear part covering the white area of the eyes). Both of these conditions are benign growths, typically appearing on one side or both sides adjacent to the cornea (transparent layer forming the frontal part of the eye). Whilst pinguecula and pterygium share similar features, they are two distinctive eye conditions.1 It is important to be able to distinguish between pinguecula and pterygium, considering that they have different phenotypes and treatment options.
Symptoms
Pinguecula
Pinguecula appears as a raised white or yellow growth on the conjunctiva composed of deposits of fats, calcium, and protein. It usually does not grow on the cornea and typically appears on the inner side of the eye, closer to the nose, but it can occur on the other side.2 For the majority of people, pinguiculas do not cause problems with vision, but it can interfere with the tears coating the eyes resulting in redness, dryness and possibly inflammation.3
Symptoms
Some of the most common symptoms associated with pinguecula are:
- Small yellow or white growths on the eye
- Can have multiple pinguecula in the same eye
- It can occur simultaneously on both eyes
- Redness
- Irritation
- Dryness4
Pterygium
Pterygium, sometimes referred to as Surfer’s eye, is the growth of fleshy tissue which has blood vessels. Normally, pterygium occurs only one side of the eye at a time but can easily spread and grow to the cornea, resulting in the distortion of vision and inducing astigmatism (blurred distance and near vision).1
Symptoms
Some of the most common symptoms associated with pterygium include:
- Fleshy triangular growth on the side of the eye
- Reduction of vision
- Foreign body sensation
- Redness, irritation and inflammation of the eye1
Causes
The causes of pinguecula and pterygium are similar and are predominantly due to exposure to ultraviolet (UV) light, wind and dust.
Pinguecula
Sun exposure
Sun exposure is one of the most common causes of pinguecula due to the long-term exposure to ultraviolet (UV) radiation, which damages the cornea. In general, people who spend time outdoors are at a higher risk of developing pinguecula but this can take months or years depending on the levels of constant exposure.1
Ageing
With age, the risk of getting pinguecula increases. It is estimated that every 80 year old individual has experienced pinguecula at least once in their lifetime.4 This is due to a variety of factors such as occupation, environmental factors and UV exposure. It normally starts affecting people over the age of 40.5
Environmental factors
Environmental factors like exposure to dry and dusty environments also increase the likelihood of developing pinguecula. This is because the dust particles enter the eye and may cause redness or irritation which are both key symptoms of pinguecula. Therefore, due to historical outdoor occupations, males are at a higher risk of developing pinguecula compared to females.5
Pterygium
Sun exposure
There is a high correlation between the development of pterygium and sun exposure. This is due to the UV light emitted by the sun. Those who spend the majority of their time outdoors are at a higher risk of developing pterygium. In addition, spending time in the snow and water can also increase the likelihood of getting pterygium due to the additional light reflected from the surfaces. Pterygium is also more common in regions with higher ozone depletion due to UV rays being able to pass easily.6
Wind exposure
Exposure to dry and windy environments has been linked to pterygium as it can easily aggravate the symptoms associated with pterygium, like dry eyes. In addition, wind exposure may also cause dust or dirt, which is also linked to pterygium, to enter the eyes. 6
Age
Pterygium is more prevalent in people between the ages of 20 and 50 and more likely to appear in males. This can be due to environmental factors or occupational hazards due to their association with dry and dusty environments.6
Diagnosis
The diagnosis of both pterygium and pinguecula is similar and essential as it will determine the future course of treatment.
Eye examination
An examination is one of the first steps in diagnosing pterygium and pinguecula, usually using a slit-lamp eye examination (shining a light through a microscope lens to visualize a patient’s eye). Due to the unique features of pterygium and pinguecula, they are relatively easy to distinguish. However, in some cases, your optometrist may need to remove a part of the growth to determine whether it is cancerous or not. Pterygium and pinguecula are both benign growths, meaning non-cancerous, but can look similar to other precancerous growths. Therefore, in some cases, it may be essential to examine the growth under a microscope.3
Medical history
Understanding the medical history of the patient, such as exposure to environmental conditions, occupational hazards, or living history, may influence the diagnosis of pterygium and pinguecula. Therefore, eye doctors may ask comprehensive questions before diagnosing.6
Physical examination
Physical examination of the eye is also an important part of diagnosing pterygium and pinguecula as it focuses on assessing the redness, inflammation and swelling of the eyes, which are all symptoms of pterygium and pinguecula.6
Treatment
Depending on the severity of the pterygium and pinguecula, the treatment options may vary. However, in general, the majority of people are prescribed similar treatments.
Pinguecula
Considering that the majority of the time, pinguecula does not affect eye vision and only causes discomfort, eye doctors normally prescribe lubricating eye drops and artificial tears to moisten the eye. However, for cosmetic purposes, it is possible to surgically excise the pinguecula.
Lubricating eye drops
One of the common symptoms of pinguecula is dryness, itchiness and redness of the eyes. To alleviate these symptoms, lubricating eye drops is ideal. In severe cases of pinguecula, eye doctors may prescribe topical steroid eye drops for a short period of time to reduce the inflammation or swelling.4
Artificial tears
Artificial tears are another alternative that helps with dryness and dust particles that may have entered the eyes.5 It is recommended to use artificial tears several times a day, however, it may be better to choose preservative-free artificial tears as they can be gentler on the front layers of the eyes.3
Pterygium
Pterygium is more severe compared to pinguecula, as it can cause blurry and distorted vision.
Surgery
Pterygium surgery is normally used to remove the growth from the eye in an operating room. The surgery usually takes approximately half an hour to an hour. However, if the surgery is required on both eyes, it may be done on separate days. Depending on the severity and size of the pterygium, the surgical procedure differs. After the removal of the pterygium, in some cases, the doctor may move a part of the conjunctiva (clear membrane protecting your eye) from the healthy side of the eye to the area of the pterygium. In other cases, doctors will use a supportive tissue known as an amniotic membrane instead, allowing the healing of the eye to happen naturally. The post-operative procedure normally includes the application of a patch to reduce the bleeding and protect the eye from infection. The doctor may also prescribe antibiotics and steroid drops to reduce the likelihood of the eye getting infected and reduce redness and inflammation.3
Eye drops
Eye drops are a great temporary solution for pterygium as they keep the eyes lubricated, alleviating the symptoms of pterygium. Depending on the severity of the pterygium, different eye drops may be recommended. Ensure that these drops are stored at the recommended temperature and are not use by anyone else. For more mild cases, artificial tears may be the solution, especially if applied several times throughout the day. For more severe cases, doctors may prescribe steroid eye drops to be used under a short period of time.6
Prevention
To minimise the risk of developing either condition, one of the best ways is to take preventative precautions, including:
Sunglasses
To avoid UV exposure from the sun, one of the best preventative measures is to wear sunglasses. Some lenses, like the high index, can block both ultraviolet A and ultraviolet B radiation.5
Wearing hats
Wearing wide-brimmed hats, especially on very sunny days, is an alternative to shield the eyes from UV radiation. It has been estimated that around 30% of UV rays are blocked and prevented from reaching the eyes when wearing wide-brimmed hats. 5
Using eye drops
Eye drops and artificial tears are great for keeping the eyes moist and alleviating symptoms of pterygium and pinguecula, especially dryness, inflammation and foreign bodies. Depending on the severity of the eye condition, different eye drops may be advised, whereas people with more severe cases may be prescribed steroid eye drops for a short period of time.5
Regular eye exams
One of the key preventative measures that can be taken to prevent pterygium and pinguecula is to have regular eye exams. Going regularly to your local eye doctor it allows the examination of the eyes and will allow identification of either pterygium or pinguecula at an early stage before spreading and requiring more invasive treatment options
Summary
To summarise, pterygium and pinguecula are two common eye conditions occurring on the conjunctiva (protective membrane) of the eye. Pinguecula refers to a yellow and white growth, whilst pterygium refers to a fleshy growth. While both conditions have similarities in terms of symptoms, including dryness, irritation, and redness, it is very important to distinguish between the conditions. Both pterygium and pinguecula are caused by constant exposure to UV radiation and other environmental factors. Therefore, it is important to take preventative precautions. The treatment of both pterygium and pinguecula differs, where people with pterygium are more likely to undergo surgery due to the severity and impact it has on their eyesight.
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