PTERYGIUM A pterygium is a non-cancerous growth of the clear, thin tissue (conjunctiva) that lays over the white part

part of the eye (sclera). One or both eyes may be involved. Pterygium refers to any winglike triangular membrane occurring in the neck, eyes, knees, elbows, ankles or digits. In the eye, a pinguecula is called a pterygium if it invades the cornea. The term comes from the Greek word pterygion meaning "wing". A pterygium grows very slowly. Usually it takes several years or decades to progress, but occasionally growth may be rapid in the presence of inflammation such as Blepharitis.

INCIDENCE rare in children

CAUSES The cause is unknown a slightly higher incidence in males than females RISK FACTORS excess outdoor exposure to sunny,dusty, sandy and windblown areas those who work outdoors such as farmers, fishermen, and people living near the equator UV radiation

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS Painless area of raised white tissue, with blood vessels on the inner or outer edge of the cornea Burning irritation A pigmented epithelial iron line (Stockers line) adjacent to a pterygium is evidence of chronicity

redness inflammation foreign body sensation

DIAGNOSTIC EVALUATIONS A physical examination of the eyes and eyelids confirms the diagnosis Special tests are usually not needed Visual acuity with current correction and manifest refraction External examination (lids, lashes, lacrimal apparatus) Examination of bulbar and palpebral conjunctiva as well as fornices Slit lamp biomicroscopy of the ocular surface and anterior segment Keratometry Corneal Topography Motility Exam The remainder of a comprehensive eye exam to include pupil exam, visual fields, intraocular pressure, and dilated funduscopic exam

MEDICAL MANAGEMENT Excision: simple excision or simple conjunctival closure will result in a recurrence rate as high as 80% and is now considered unacceptable. Excision together with adjunctive therapies such as radiotherapy, mitomycin and 5FU: the use of these adjunctive agents will reduce the 80% recurrence of simple excision to about 10% but bring with them some visually threatening complications. The only real advantage of these methods is the simplicity and speed of the surgery. Conjunctival Flap/Graft : this is considered the Gold Standard of care and carries an approximate rate of recurrence of 5-10% with minimal complications. However, it is a lengthier procedure and technically slightly more complicated than those methods above. Recently a major modification of a routine autograft, known as P.E.R.F.E.C.T. for PTERYGIUM, has reduced the recurrence rate to 1/1000 and results in a cosmetic result where the appearance of the eye after this procedure is indistinguishable from that of a normal eye. Intensive postoperative topical steroids may be required. Patients need to be followed for one year if a recurrence is to be identified. 97% of all recurrences occur in the first year after surgery.

NURSING MANAGEMENT

 NURSING DIAGNOSIS

PREVENTION Wear protective glasses and a hat with a brim to prevent the condition from returning.

EXPECTATIONS (PROGNOSIS) Most pterygia cause no problems and do not need treatment. If a pterygium affects the cornea, results are usually good after it is removed. COMPLICATIONS Recurrence Corneal scarring Corneal perforation Strabismus Non-healing epithelial defect (esp with mitomycin C) Scleral melt (esp with mitomycin C)