A pinguecula (pin-GWEK-yoo-la) is a yellowish patch or bump of the conjunctiva (the transparent, filmy membrane covering the sclera, the white of the eye), near the cornea (the clear front “window” where contact lenses sit). It can be a result of deposit of protein, fat and/or calcium, technically, similar to skin callus. Frequently, pingueculae can lead to the formation of pterygia.
Wearing sunglasses and hats when outdoors can reduce your chances of developing pingueculae.
A pterygium (tur-RIJ-ee-um), (pterygia (tur-RIJ-ee-a, plural), aka Surfer’s Eye is an elevated, wedge-shaped benign (non-cancerous) growth of fleshy tissue and blood vessel that extend over the cornea and can become large enough to obstruct one’s vision and/or permanently disfigure the eye. As with pingueculae, prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia. For this reason, and because pterygia frequently affect surfers and other people who spend a lot of time outdoors in the sun, another term used to describe the condition is “surfer’s eye.”
If a pterygium becomes large or inflamed, surgical removal may be necessary.
Both pingueculae and pterygia typically appear in areas most exposed to sun, in other words, on the sides rather than top and bottom, and can affect one eye or both eyes. Both types of growths are caused by dry eye and environmental elements such as wind, dust and ultraviolet light (UV) — especially common among those between 20 to 50 years old who are often outdoors for extended periods without protection by sunglasses or hats, such as surfers, skiers, farmers, hikers and athletes.
The damage caused by UV rays is not something that will only appear and affect us later in life. The effects and damage from long periods of exposure in the sun can have consequences in our twenties and even our teenage years. Conditions such as pinguecula and pterygium which are both growths on the eye can appear in early adult hood thanks to extended sun exposure.
What are the signs and symptoms of pinguecula and pterygia?
In most people, pingueculae cause few symptoms. But a pinguecula that is irritated might cause dryness, itching, and burning, creating a sandy, gritty feeling that something is in the eye (“foreign body sensation”). In some cases, pingueculae become swollen and inflamed, a condition called pingueculitis. Irritation and redness from pingueculitis often result from exposure to sun, wind, dust or extremely dry conditions resulting in blurred or fluctuating vision.
Pterygium can give the sufferer the feeling of having something pesky and annoying stuck in their eye constantly. Many people with mild surfer’s eye do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a gritty sensation or the feeling something is “in” the eye (called a foreign body sensation). A large, advancing pterygium also can distort the shape of the front surface of the eye and cause astigmatism.
Itching, burning, redness and inflammation are all symptoms of these two conditions. The appearance and sensation of the growth itself upon blinking may also add to the symptoms.
Can they be treated or prevented?
In many cases, not treatment is necessary. Lubricating eye drops or ointments may be prescribed for mild pingueculitis to relieve dry eye irritation and foreign body sensation. Steroid eye drops or nonsteroidal anti-inflammatory drugs (NSAIDs) may be needed to relieve significant inflammation, redness and swelling.
Surgical removal of the pinguecula and pterygium by an Ophthalmologist may be considered in severe cases when it threatens sight or cause persistent discomfort such as with contact lens wear or blinking. They are also sometimes removed for cosmetic reasons.
Despite proper surgical removal, pterygium or pinguecula may, and often do, return. Reoccuring pterygium are often 30-40% of reported cases and are most common in people under 40. Risk of recurrence also appears to vary among ethnic groups, with Hispanics having a greater risk of pterygium recurrence than caucasians. Also of note is that pterygium removal can induce astigmatism, especially in people who already have astigmatism. Surface radiation or medications are sometimes used to help prevent recurrences. However, the best way to avoid recurrences is to limit exposure to the environmental factors that contribute to their growth.
Like many conditions of the eye, these growths are PREVENTABLE. Adequate protection to prevent occurrence or limit progression of pinguecula or pterygium includes wide-brimmed hats, sun screen or veil, proper sunglasses or eyewear, and artificial tears.