Pterygium (conjunctiva) - Wikipedia, the free encyclopedia

26/04/15 03:51

Pterygium (conjunctiva)
From Wikipedia, the free encyclopedia

Pterygium (Surfer's Eye) most often

refers to a benign growth of the
conjunctiva. A pterygium commonly
grows from the nasal side of the
sclera. It is usually present in the
palpebral fissure. It is associated with
and thought to be caused by
ultraviolet-light exposure (e.g.,
sunlight), low humidity, and dust.
Growth has been known to be
preceded with scleral trauma around
the Palpebral comissure. The
predominance of pterygia on the
nasal side is possibly a result of the
sun's rays passing laterally through
the cornea, where it undergoes
refraction and becomes focused on
the limbic area. Sunlight passes
unobstructed from the lateral side of
the eye, focusing on the medial
limbus after passing through the
cornea. On the contralateral (medial)
side, however, the shadow of the
nose medially reduces the intensity
of sunlight focused on the

Pterygium (conjunctiva)

Pterygium removal surgery

Classification and external resources
ICD-10

H11.0
(http://apps.who.int/classifications/icd10/browse/2015/en#/H11.0)

ICD-9

372.4 (http://www.icd9data.com/getICD9Code.ashx?icd9=372.4)

DiseasesDB 10916 (http://www.diseasesdatabase.com/ddb10916.htm)

MedlinePlus 001011
(http://www.nlm.nih.gov/medlineplus/ency/article/001011.htm)
eMedicine

oph/542 (http://www.emedicine.com/oph/topic542.htm)

MeSH

D011625 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D011625)

lateral/temporal limbus.[1]

Contents
1 Pathology
2 Prevention
3 Symptoms
4 Treatment
5 See also
6 References
7 External links

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Pathology
Pterygium in the conjunctiva is characterized by elastotic degeneration
of collagen (actinic elastosis[2]) and fibrovascular proliferation. It has an
advancing portion called the head of the pterygium, which is connected
to the main body of the pterygium by the neck. Sometimes a line of iron
deposition can be seen adjacent to the head of the pterygium called
Stocker's line. The location of the line can give an indication of the
pattern of growth.
The exact cause is unknown, but it is associated with excessive exposure
to wind, sunlight, or sand. Therefore, it is more likely to occur in
populations that inhabit the areas near the equator, as well as windy
locations. In addition, pterygia are twice as likely to occur in men than
women. Some research also suggests a genetic predisposition due to an
expression of vimentin, which indicates cellular migration by the
keratoblasts embryological development, which are the cells that give
rise to the layers of the cornea. Supporting this fact is the congenital

Pterygium growing onto the cornea

pterygium, in which pterygium is seen in infants.[3] These cells also

exhibit an increased P53 expression likely due to a deficit in the tumor
suppressor gene. These indications give the impression of a migrating
limbus because the cellular origin of the pterygium is actually initiated
by the limbal epithelium.[4]
The pterygium is composed of several segments:
Fuchs' Patches (minute gray blemishes that disperse near the
pterygium head)

Micrograph of a conjunctiva
associated with prominent blood
vessels (left-bottom of image) and
elastotic collagen (centre of image),
as may be seen in a pterygium. H&E
stain.

Stocker's Line (a brownish line composed of iron deposits)

Hood (fibrous nonvascular portion of the pterygium)
Head (apex of the pterygium, typically raised and highly vascular)
Body (fleshy elevated portion congested with tortuous vessels)
Superior Edge (upper edge of the triangular or wing-shaped portion of the pterygium)
Inferior Edge (lower edge of the triangular or wing-shaped portion of the pterygium).

Prevention
As it is associated with excessive sun or wind exposure, wearing protective sunglasses with side shields and/or
wide brimmed hats and using artificial tears throughout the day may help prevent their formation or stop further
growth. Surfers and other water-sport athletes should wear eye protection that blocks 100% of the UV rays from
the water, as is often used by snow-sport athletes.

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Symptoms
Symptoms of pterygium include persistent redness from smoking, inflammation,[5] foreign body sensation,
tearing, which can cause bleeding, dry and itchy eyes. In advanced cases the pterygium can affect vision[5] as it
invades the cornea with the potential of obscuring the optical center of the cornea and inducing astigmatism and
corneal scarring.[6][7]

Treatment
Today a variety of options are available for the management of pterygium, from irradiation, to conjunctival
auto-grafting or amniotic membrane transplantation, along with glue and suture application. As it is a benign
growth, pterygium typically does not require surgery until it grows to such an extent that it covers the pupil,
obstructing vision or presents with acute symptoms, or pulls on the cornea, distorting vision. Some of the
irritating symptoms can be addressed with artificial tears. However, no reliable medical treatment exists to
reduce or even prevent pterygium progression. Definitive treatment is achieved only by surgical removal. Longterm follow up is required as pterygium may recur even after complete surgical correction. There is a new and
effective treatment using Mitomycin .01% solution (Mobius makes a kit) to keep the Pterygium from recurring.
Please do some further research before deciding to do some of these outdated procedures.
If there is recurrence after surgery or if recurrence of pterygium is thought to be vision threatening, it is possible
to use strontium (90Sr) plaque therapy. 90Sr is a radioactive substance that produces beta particles, which
penetrate a very short distance into the cornea at the site of the operation. It suppresses the regrowth of blood
vessels that occur with return of the pterygium. The treatment requires some local anaesthetic in the eye and is
best done at the time of, or on the same day as the pterygium excision.
The 90Sr plaque is a concave metal disc about 1-1.5 cm in diameter that is hollow and filled with an insoluble
strontium salt. The side placed on the eye is a very thin and delicate silver film that will contain the strontium
but allow the beta particles to escape. The dose of radiation to the conjunctiva is controlled by the time that the
plaque is left in contact with the surface. The integrity of the plaque surfaces is paramount to prevent exposure
to patients and so is wipe tested to see if radioactive matter is escaping. Obviously this test must be done very
very gently.
Conjunctival auto-grafting is a surgical technique that is effective and safe procedure for pterygium removal.
When the pterygium is removed, the tissue that covers the sclera known as the conjunctiva is also extracted.
Auto-grafting replaces the bare sclera with conjunctival tissue that is surgically removed from the temporal
healthy conjunctiva. That self-tissue is then transplanted to the bare sclera and is fixated using sutures, tissue
adhesive, or glue adhesive.
Amniotic membrane transplantation is an effective and safe procedure for pterygium removal. Amniotic
membrane transplantation offers practical alternative to conjunctival auto graft transplantation for extensive
pterygium removal. Amniotic membrane transplantation is tissue that is acquired from the innermost layer of
the human placenta and has been used to replace and heal damaged mucosal surfaces including successful
reconstruction of the ocular surface. It has been used as a surgical material since the 1940s, and has been shown
to have a strong anti-adhesive effect.[8][9] Using an amniotic graft facilitates epithelialization, and has antihttp://en.wikipedia.org/wiki/Pterygium_(conjunctiva)

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inflammatory as well as surface rejuvenation properties. Amniotic membrane transplantation can also be fixated
to the sclera using sutures, or glue adhesive.[10] [11] [12] [13] [14] Amniotic membrane transplantation with
Tisseel glue application and Mitomycin-C has shown excellent cosmetic outcomes with a surface free of
redness, stitching, or patches, which makes the ocular surface suitable for vision correction surgery sooner.[15]
[16] [17]

See also
List of eye diseases and disorders
Pinguecula

References
1. Coroneo, MT (November 1993). "Pterygium as an early indicator of ultraviolet insolation: a hypothesis"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC504636). Br J Ophthalmol 77 (11): 7349. doi:10.1136/bjo.77.11.734
(https://dx.doi.org/10.1136%2Fbjo.77.11.734). PMC 504636 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC504636).
PMID 8280691 (https://www.ncbi.nlm.nih.gov/pubmed/8280691).
2. Klintworth, G; Cummings, T. "24; The eye and ocular adnexa". In Stacey, Mills. Sternberg's Diagnostic Surgical
Pathology (5 ed.). ISBN 978-0-7817-7942-5.
3. http://www.paramountbooks.com.pk/LoginIndex.asp?title=Concise-Ophthalmology(pb)-2014&Isbn=9789696370017&opt=3&sUBcAT=06
4. Gulani, A; Dastur, YK (JanMar 1995). "Simultaneous pterygium and cataract surgery."
(http://www.jpgmonline.com/article.asp?issn=00223859;year=1995;volume=41;issue=1;spage=8;epage=11;aulast=Gulani). Journal of postgraduate medicine 41 (1): 811.
PMID 10740692 (https://www.ncbi.nlm.nih.gov/pubmed/10740692). Retrieved 30 November 2012.
5. Kunimoto, Derek; Kunal Kanitkar; Mary Makar (2004). The Wills eye manual: office and emergency room diagnosis and
treatment of eye disease. (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 5051. ISBN 978-0781742078.
6. Gulani, A.C. (24 March 2005). "Extended Sun Exposure Increases Risk of Eye Pterygium"
(http://www.prweb.com/releases/2005/3/prweb221035.htm).
7. Fisher, J.P.; Trattler, W.B. (12 January 2009). "Pterygium" (http://emedicine.medscape.com/article/1192527-overview).
8. Trelford, JD; Trelford-Sauder, M (1 August 1979). "The amnion in surgery, past and present.". American journal of
obstetrics and gynecology 134 (7): 83345. PMID 380345 (https://www.ncbi.nlm.nih.gov/pubmed/380345).
9. Tayyar, M; Turan, R; Ayata, D (June 1993). "The use of amniotic membrane plus heparin to prevent postoperative
adhesions in the rabbit.". The Tokai journal of experimental and clinical medicine 18 (1-2): 5760. PMID 7940608
(https://www.ncbi.nlm.nih.gov/pubmed/7940608).
10. .Gulani AC. "Corneoplastique SASRCS, Durban. August 2005.
11. Gulani AC. Advanced Corneal Surgery Course: AAO, California, Oct 2006
12. Gulani AC. Corneoplastique. Techniques in Ophthalmology 5(1): 11-20, 2007.
13. Gulani AC. Corneoplastique, Video Journal of Cataract and Refractive Surgery. Volume XXII. Issue 3, 2006.
14. Gulani AC. "A New Concept for Refractive Surgery", Ophthalmology Management 2006; 10 (4). 57-63.
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15. Gulani AC. Vision Corrective Surgeries: Past Techniques, Present Trends and Future Technologies, North East Florida
Medicine. 2007; 2 (58) 41-44.
16. Gulani AC, Holladay J, Belin M, Ahmed I. Future Technologies in LASIK- Pentacam Advanced Diagnostic for Laser
Vision Surgery. In Experts Review of Ophthalmology, 2008- London
17. Gulani AC. Corneoplastique: Art of Laser Vision Surgery- Corneal Refractive Surgery in Video Atlas of Ophthalmic
Surgery. XXXVIII. (2) 2008

External links
Media related to pterygium at Wikimedia Commons
Facts About the Cornea and Corneal Disease (http://www.nei.nih.gov/health/cornealdisease/index.asp)
The National Eye Institute (NEI)
Pterygium (http://emedicine.medscape.com/article/1192527-overview) eMedicine WebMD online article
on pterygium (overview, differential diagnoses & workup, treatment & medication, and follow-up)
2014.
Retrieved from "http://en.wikipedia.org/w/index.php?title=Pterygium_(conjunctiva)&oldid=653635088"
Categories: Disorders of conjunctiva
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