Treating Surfer’s Eye: What Is Pterygium Surgery?
Surfer’s Eye is a colloquial phrase used to describe a pterygium, an abnormal and elevated growth of tissue that extends from the conjunctiva (the clear tissue that covers the white part of your eye) to the cornea (outer protective layer of the eye). While many cases of pterygium can be managed with eye drops, some people may require surgery. This blog will explain what a pterygium looks and feels like and discuss which surgical options are available to treat this condition.
What Is Surfer’s Eye?
Pterygium, which comes from the Greek word for wing, typically grows from the inner eye near the nose toward the cornea. Sometimes, it may also grow from the outer eye (from the ear side) toward the cornea. Pterygium may present in a wing-like shape. It is also sometimes referred to as an “eye web.”
It is unclear what causes pterygium, although environmental factors are believed to be the leading risk factor. The name Surfer’s Eye (or sometimes Farmer’s Eeye) comes from the fact that long-term exposure to sun, wind, and dusty conditions – things surfers and farmers experience – can lead to pterygium. Concurrent dry eye disease is also very common in patients with pterygium.
However, it can happen to anyone who spends most of their time outdoors, especially without wearing a hat and sunglasses. Pterygium is more prevalent in countries close to the equator, such as those in South America and Africa.
If you are exposed to UV rays, wind, and dust on a regular basis, it is important to keep your eyes healthy by wearing sunglasses, glasses, or goggles, and using artificial tears to moisten your eyes.
Pinguecula vs. Pterygium
Some people who have pterygium may confuse it with pinguecula, a similar eye condition in which a raised yellow or white growth occurs on the conjunctiva.
The main difference between the two is that pterygium can increase in size and affect the cornea, while pinguecula is limited to the conjunctiva. In addition, pinguecula forms from fat deposits, protein, or calcium, which is different from the tissue that forms a pterygium.
In most cases, pinguecula does not affect your vision, and eye drops (over-the-counter lubricating drops or prescription steroid drops) can alleviate symptoms. Thus, surgery is not usually required. On the other hand, cases of pterygium may require surgical treatment.
Visually, a raised pink, white, or red lesion on the conjunctiva is the most common way to identify pterygium. You may also experience redness, irritation, and a feeling like you have something in your eye such as a piece of sand.
As the pterygium progresses to the cornea, you may develop decreased or blurry vision. If it reaches the cornea, the shape of your eye may change and lead to astigmatism.
Symptoms may take years to develop, as the abnormal tissue develops slowly. It may also start and stop growing throughout your life.
Many cases of pterygium remain mild and can be treated with eye drops. However, pterygium that grows onto the cornea can impact vision and cause severe pain that requires surgery. Surgery may also be an option if eye drops or ointments are unable to treat symptoms. Some people may opt for surgery for cosmetic reasons. In other cases, a pterygium may need to be removed prior to cataract surgery.
For pterygium surgery, an ophthalmologist removes the growth from your eye and, depending on the individual case, may use tissue or a piece of healthy conjunctiva to prevent pterygium from returning. This minimally invasive surgery takes between 30 minutes to an hour. Some people may require pterygium surgery in both eyes, in which case the procedures will take place separately so you can still see out of one eye.
Here are the types of pterygium surgery your ophthalmologist may perform:
- Pterygium excision: Also called bare sclera pterygium removal, the head and body of the pterygium are removed while the sclera is left to heal. Unfortunately, there is a high rate of recurrence after this procedure, and pterygium may return even larger than before. This type of procedure is rarely performed in modern times.
- Excision with Mitomycin C: Once the pterygium is excised, your ophthalmologist will administer Mitomycin C (MMC), a medication to prevent pterygium from growing back. MMC works by inhibiting fibroblasts, a type of cell that contributes to the formation of connective tissue. A popular anti-cancer drug, 5-fluorouracil, may also be used in place of MMC.
- Excision with conjunctival autograft: This popular approach involves removing the pterygium and filling the gap of conjunctival tissue with transplanted tissue from the upper white part of the eye. A conjunctival autograft is associated with a much reduced rate of pterygium recurrence (less than 10%). This surgery is longer and requires an experienced eye surgeon with strong technical skills.
- Excision with amniotic membrane tissue: Used as an alternative to conjunctival autograft, the pterygium is excised and amniotic membrane tissue is glued or sutured to the affected area to help it heal, with a low risk of recurrence. Your ophthalmologist may choose this type of surgery if you are at risk for glaucoma as an intact conjunctiva is advantageous who might require future glaucoma surgery. Many surgeons prefer this technique to avoid damage to the conjunctiva and minimize scarring.