Background
Pterygium (also known as surfer's eye) is a fleshy triangular growth that can occur on the bulbar conjunctiva of the eye at the 3 and 9 o'clock meridians. [1] It can spread across and distort the cornea, leading to changes in vision. Pterygia can vary in size and severity, from small, inactive lesions to large, rapidly growing ones that can affect the corneal topography. Treatment options include lubricating eye drops, steroids, and surgical removal if necessary. Prevention involves protecting the eyes from UV exposure and monitoring any changes in vision through regular eye exams. [2, 3, 4]
Pathophysiology
The pathophysiology of pterygium is characterized by elastotic degeneration of collagen and fibrovascular proliferation, with an overlying covering of epithelium. Histopathology of the abnormal collagen in the area of elastotic degeneration shows basophilia with hematoxylin and eosin stain. This tissue also stains with elastic tissue stains, but it is not true elastic tissue, in that it is not digested by elastase. [2, 3]
Epidemiology
The incidence of pterygium in the United States and internationally varies with geographic location, with higher prevalence rates seen in lower latitudes where there is increased exposure to ultraviolet light. [1, 5, 6] Prevalence rates in the continental U.S. range from less than 2% above the 40th parallel to 5-15% between latitudes 28-36°. [5, 6] Internationally, studies show a prevalence of pterygium between 1% and over 30%, with a pooled prevalence around 10%. [7] Risk factors for pterygium include age, male sex, outdoor job exposure, low education, rural residence, low income, darker skin complexion, and smoking. The highest prevalence rates are found around the equator, with rates more than 10 times higher than those outside this area, highlighting the significant role of ultraviolet irradiation in pterygium pathogenesis. [8]
Frequency
United States
The incidence of pterygium within the United States varies with geographic location. [1] Within the continental United States, prevalence rates vary from less than 2% above the 40th parallel to 5-15% in latitudes between 28-36°. A relationship is thought to exist between increased prevalence and elevated levels of ultraviolet light exposure in the lower latitudes. [5, 6]
International
Internationally, the relationship between decreased incidence in the upper latitudes and relatively increased incidence in lower latitudes persists.
Mortality/Morbidity
A pterygium can cause a significant alteration in visual function in advanced cases. It can become inflamed, resulting in redness and ocular irritation.
Sex
Pterygium is reported to occur in males twice as frequently as in females.
Age
It is uncommon for patients to present with pterygium prior to age 20 years. Patients older than 40 years have the highest prevalence of pterygia, whereas patients aged 20-40 years are reported to have the highest incidence of pterygium.
Prognosis
The visual and cosmetic prognosis following pterygium excision is good. The procedures are well tolerated by patients, and, aside from some discomfort in the first few postoperative days, most patients are able to resume full activity within 48 hours of their surgery. Those patients who develop recurrent pterygia can be retreated with repeat surgical excision and grafting, with conjunctival/limbal autografts or amniotic membrane transplants in selected patients. [9, 10]
Patient Education
Patients with pterygium should reduce exposure to ultraviolet light whenever possible. Methods of reducing ultraviolet exposure include wearing ultraviolet-blocking sunglasses, wearing a cap with a wide brim, and seeking shade from direct sunlight. [4]
Patients who are at high risk for the development of pterygium because of a positive family history of pterygia or because of extended exposure to ultraviolet irradiation need to be educated in the use of ultraviolet-blocking glasses and other means of reducing ocular exposure to ultraviolet light.
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