If you value your eyes choose Dr.Khanna because:
- Pterygium surgery experience of close to three decades.
- Has been successful with multiple techniques for over 25 years.
- Uses the latest, safest, cosmetic technique with the least chance recurrence happening.
- #1 choice of movie stars, newsreaders and physicians.
- Board Certified by American Board of Ophthalmology.
- Pain-free surgery in operating suite.
Color OCT of Pterygium showing delineation from cornea (red elevation on the right)
Elastotic subhyaloid degeneration of the conjunctiva.
What is Pterygium or Surfer Eye?
A pterygium is a light reddish or pinkish, elevated, triangular growth of tissue on the eyeball that begins on the white of the eye, also known as the sclera. This tissue growth can get into the cornea, which is the outer, transparent layer of the eye, through which light enters the eye. Pterygium usually begins on the cornea near the nose. It might also gradually expand to a bigger size that will then cover the pupil. If someone has more than one of these eye growths, the plural form of the word is pterygia. Pterygia are benign (non-cancerous) growths, however they can become cancerous.
Though it’s generally called “surfer’s eye,” you do not need to be a surfer, or ever before have seen the sea, to suffer from a pterygium. However, being in intense sunshine for lengthy hours — specifically when you get on the water, which reflects the sunlight’s harmful UV rays – raises your risk.
An elevated, yellowish nodular growth on the conjunctiva. It is non-cancerous, but cosmetically unsightly. Its etiology, prevention and treatment are similar to pterygia. Infact, it may be considered an early stage of pterygium.
Causes of Pterygium development
Although ultraviolet radiation from sunlight seems the main reason for the growth and development of pterygia, dirt, as well as wind, are also linked in some cases. Another reason for the growth is complete dry eye illness. Pterygia generally establishes itself in 30-year-olds to 50-year-olds. These bumps on the eyeball are hardly ever seen in youngsters. Having light skin, as well as light eyes, may place you at enhanced risk of getting a pterygium.
Symptoms of Pterygium
Pterygium is a callus like growth on the clear part of the eye (the cornea). It can be unsightly and people hate how it looks. A lot of people mistakenly assume the person is drunk. It can make life difficult at work, especially if you are making a presentation to close a big deal. You may have spent a lot of time in front of the mirror wondering why your eyes always turn red, or looking at a growth covering the white part of your eye. Pingecula causes similar symptoms.
Pterygium, unlike pingecula, also affects a person’s vision, either by inducing astigmatism, or in later stages marching towards the pupil. In extreme cases a person can lose all vision.
Before and After of Cosmetic Pterygium Surgery
Right eye fan shaped pterygium - Betadine prep before procedure.
Right eye pterygium removal done and autograft glued.
Left eye pytergium in a young hispanic woman who travelled from central California.
Left eye beautiful outcome a day after pterygium surgery
Bilateral pterygium in a young lady being prepped for surgery
After bilateral cosmetic pterygium procedure in the same young woman - 2 weeks
(Before) Pterygium in the right eye of a gardner.
(After) Day 1 cosmetic pterygium procedure
Surfer's left eye - Pterygium invading on the cornea
(After) Left eye next day after pterygium cosmetic procedure
We will arrange a FREE Zoom or FaceTime consult with the Pterygium Surgeon!
Prevention of Pterygium
There are two ways to prevent onset or progression of Pterygium:
1. Avoid UV radiation
Wear wide brimmed hats and sunglasses. If you are a surfer, try tinted swimming goggles. Decreasing UV radiation prevents degeneration of conjunctiva.
2. Treat dry eyes
Preservative free artificial tears, ointment, medicated drops etc. Read more about dry eyes.
Pingecula or Pterygium Drops
Drops are a very important part in our fight against a pingecula transforming into a pterygium, progression of pterygium and the prevention of recurrence. At Khanna Institute, we believe surgery should be the last resort. We are proud to say we have avoided surgical procedures in many patients by judicious use of the following drops and accessories:
- Water droplets: The simplest method to hydrate the eye is to sprinkle them with water. A humidifier is a cost effective, great way to keep the eyes moist over time. Washing your eyes by dipping them in a cup full of cool, filtered water serves to hydrate them, as well as remove trapped allergens.
- Artificial tears: The most popular method in America. Preservative free, artificial tears of various brands come in single use, plastic containers. They are better than multidose bottles which have preservatives and may be toxic to cornea.
- Ointments: Most pharmaceutical companies that make artificial tears also make eye ointments. These are better than drops because they require use only at nighttime. They stick to cornea and coat it. Only a little amount should be used at a time.
- Ayurvedic drops: For hundreds of years these have proven useful in the Indian subcontinent and beyond. Gulab jal is made from rose petals. We provide freshly made drops from organically grown roses.
- Medicated drops: Restasis was the first to be introduced, followed by the quicker acting Xiidra. Now Cequia has been introduced. These are all available (by prescription only).
- Solid drops: A solid, small cylindrical rod is inserted between the lid and the eye by the patient. This material slowly dissolves, providing artificial tears.
- Tear preservers: Small microscopic rods made of collagen or synthetic material are inserted in the the drainage pathway of the tears by an accomplished surgeon in a quick procedure in the office. These preserve the natural tears which have properties to fight the growth of pingecula.
- Anticancer medicine: Mitomycin C is an anticancer agent which has shown to shrink pterygium. It can be used as drops or the surgeon can inject it under the pterygium, especially recurring ones.
Indications for Pterygium Surgery:
There are two important considerations to keep in mind when thinking of getting your pterygium removed. If it begins to grow, it needs to be removed before it causes permanent visual changes. Secondly, meticulous surgery by a skilled pterygium surgeon is required to get good cosmetic result and prevent recurrence.
Causes astigmatism, affecting vision.
Invades the center of the cornea, preventing light to enter the eye.
Restriction of eye movement.
Dry eyes due to interference in the spread of tears.
High schooler or college going person may find social interaction challenging.
At work people often think a person with surfers eye is drunk.
Being on blood thinners or having an active bleeding disorder.
Differentiate from Pesudopterygium
Psudopterygium is a condition where conjunctiva covers an inflamed portion of cornea. Pterygium can be differentiated from psudopterygium by doing a probe test. In a pterygium, a probe can be passed between the pterygium and the eyeball.
Before the Procedure:
- You should discontinue blood thinners, like aspirin or warfarin.
- Control dry eyes with preservative free artificial tears.
- Start antibiotic and steroid drops or ointment.
Day of Procedure:
- Relax, take an anxiolytic (anxiety reducing medication).
- Bring along your favorite music to listen to during the procedure.
- Mark out the entire pterygium and excise it.
- Remove the pterygium entirely from the cornea. Polish the remaining fibers to leave a clear surface.
- Micro-dissect the scaffolding on which the pterygium grows.
- Avoid excessive bleeding which can cause prolonged redness and swelling. Cauterize all bleeders.
- Cover the bare area where the pterygium was removed with conjunctival autograft or aminograft allograft using tissue or other bio glue. This is a very important step. Previously, stitches were used to close the wound, but they can induce inflammation and pain. Tisseel glue is self dissolving and painless so it generates more cosmesis.
After the Operation:
- Taper the steroid and non-steroid drops instead of stopping them abruptly.
- Use punctal occluders if necessary. Keep the eye hydrated and moist.
- Watch for early recurrence.
- Treat early recurrence with anti-inflammatory drops or Mitomycin injection.
Recurrent Pterygium Management
Measure 10 times and operate once – planning is the key!
Recurrent pterygium may be considered a common side effect of pterygium surgery. If the pterygium is removed, but no attention is paid to removing the scaffold of tenon’s capsule, nor are adjunct therapies used, there is up to a 70% chance of recurrence. Recurrent pterygium management is an art and sequence. We end up helping a lot of these patients who had their primary pterygium surgery elsewhere. Pterygium are like weeds, either behead them, kill them completely or leave them alone. Never prick or irritate them because then they attack savagely.
Recurrent pterygium is worse than the original one because it can spread in all directions and have more fibrosis. This means they are more firmly attached to the muscles and surrounding eye tissue. They are also more vascular because blood vessels supply it the nutrition it needs in its march to conquer territory it had lost before.
Is your pterygium back again? The above video tells you important information about what you need to know regarding recurrent pterygium and pterygium removal.
Before operating on recurrent pterygium:
- Find out what was done in the original surgical procedure.
- Treat the dryness of the eye.
- Plan to repeat surgery in the winter or when the UV exposure is going to be a minimum.
- Inject Mitomycin C (avoid in pregnant or breast-feeding women) into the pterygium body. This anti-cancer drugs kills the cells of the pterygium, including the blood vessel cells. This causes the recurrent pterygium to shrink in size and its margins to become more defined.
- The surgery may be more painful, so attention should be directed to proper numbing of the eye and even oral or IV pain relievers.
During the procedure of recurrent pterygium:
- Identify the borders and extensions of the recurrent pterygium.
- Identify the muscles like the lateral rectus, medial rectus and the obliques and be sure to avoid trauma to them.
- If conjunctival autograft does not suffice, an allograft may be required.
- Attention to good control over bleeding is important.
- Avoid using stitches.
After surgery for recurrent pterygium:
- Close follow up is required.
- Treat emerging blood vessels aggressively.
- Taper anti-inflammatory drops slowly.
Please don’t worry if you have had a recurrence of pterygium. If you are out of the Los Angeles area you can FaceTime, Skype or Zoom with us to learn your options. If you send us your insurance card, our staff can let you know your insurance coverage.
Rajesh Khanna, MD has been performing pterygium treatment for nearly thirty years. Over the decades he has used various, prevalent techniques of pterygium surgery. Needless to say he has helped thousands of patients across the globe seeking relief. Today he has perfected the art of a cosmetic outcome with a very low chance of recurrence.
Learn more about Pterygium surgeon.
Pterygium and Lasik Eye Surgery
Pterygium, which is a callus growth on the eye, is a result of dry eye. Lasik can further increase the dryness of eyes. Hence, Lasik eye surgery may cause progression of pterygium. Depending on the decision of the surgeon, Lasik eye surgery should be avoided in the presence of pterygium.
There are several reasons why Lasik may be deemed unsafe if you have Pterygium:
- During the process of making the Lasik flap the head of the pterygium may get cut. This is a big problem for the patient because an irritated pterygium is worse for the eye.
- The pterygium may grow into the interface causing visual problems. Since the potential space allows it an unimpeded progress, it may expand in all directions lifting the flap. This results in irregular astigmatism causing ghosting of images.
- The progressive pterygium may grow over the flap. Removing it may be very difficult, as it may lift the flap.
- The pterygium may grow over and under the flap and this will affect the nutrition of the flap, leading to the destruction of the edges of the flap.
So what are the options to see better in the presence of pterygium?
- Superlasik eye surgery is a great option for people suffering with pterygium.
- Another option is Visian ICL (Implantable Collamer Lenses) inserted away from the pterygium.
- The best option is Superlasik eye surgery combined with pterygium removal. Superlasik, as you may recall, uses a highly specialized automated instrument called epikeratome. This separates the top layer of the cornea along a natural cleavage plane. The same plane is required to separate the progressive pterygium.
Therefore combining the two procedures makes a lot of sense. It does require advanced instrumentation and higher skill, but this is likely the best option to tackle two problems at once. Also, since both procedures require similar medications it saves time and money for the eye drops and it will decrease the total number of visits to the lasik eye surgeon.