Conjunctiva — Ocular surface

Pterygium: diagnosis and surgery

A pterygium is a conjunctival growth that progressively invades the cornea. When it threatens vision or causes functional discomfort, surgical excision with conjunctival autograft is the gold-standard treatment.

What is a pterygium?

A pterygium is a proliferation of vascularized conjunctival tissue that progressively invades the surface of the cornea from the inner corner of the eye (most often the nasal side). It develops in response to chronic exposure to ultraviolet light, wind and dust.

It is more common in people exposed to sunlight for prolonged periods (outdoor activities, water sports, outdoor work) and in populations living in equatorial areas. Benign in its stable forms, it can become bothersome or even threaten vision when it progresses toward the center of the cornea.

Symptoms and surgical indications

  • Persistent ocular redness on the nasal side
  • Foreign-body sensation or irritation
  • Induced astigmatism caused by the traction of the pterygium on the cornea
  • Decreased visual acuity if the pterygium reaches the visual axis
  • Significant cosmetic discomfort for some patients

A small, stable pterygium can simply be monitored. Surgery is indicated in cases of progression toward the visual axis, significant induced astigmatism, persistent functional discomfort or in preparation for refractive surgery.

Understand it visually

The pterygium: a membrane spreading onto the cornea

A pterygium is a fold of conjunctiva that advances toward the cornea, promoted by sun and wind.

Causes and risk factors

The pterygium is closely linked to cumulative exposure to ultraviolet rays, which explains its greater frequency in people who work or pursue activities outdoors, and in very sunny regions. It is sometimes called « surfer’s eye » because of its frequency among water-sports athletes.

  • Sun exposure (UV), prolonged and repeated
  • Wind, dust and dry air, which irritate the ocular surface
  • Chronic dry eye
  • An individual predisposition, the pterygium being able to appear earlier in some patients

Diagnosis

The diagnosis is clinical : slit-lamp examination allows the extension of the pterygium onto the cornea to be visualized and its degree of activity (vascularization, thickness) to be assessed. Corneal topography measures the induced astigmatism, an important element in deciding when to operate. Progression is followed through measurements and comparative photographs from one consultation to the next.

Pinguecula or pterygium ?

The pinguecula is a neighboring, yellowish lesion located on the conjunctiva near the cornea but which, unlike the pterygium, does not invade it. It is most often benign and only requires monitoring and treatment of irritation symptoms. A pinguecula may, however, progress into a pterygium.

Pterygium surgery

The gold-standard surgical treatment relies on excision of the pterygium with conjunctival autograft. After removal of the pathological tissue, a graft of healthy conjunctiva harvested from under the upper eyelid is placed over the bare area, fixed with biological glue (fibrin). This technique offers the lowest recurrence rate among the available techniques — below 5 % in published series using autograft (PMID 40596959).

Location & logistics

Clinique Sainte-Geneviève — Paris 14
29 rue Sarrette, 75014 Paris
Outpatient surgery
Local anesthesia

Postoperative course

Return home the same day
Eye drops for 4 to 6 weeks
Avoiding UV exposure recommended
Follow-up at D7, D30, D90

Preventing recurrence

After surgery, wearing sunglasses with lateral UV protection is recommended for life to limit the risk of recurrence. Recurrent pterygia are more difficult to treat and may require the use of amniotic membrane or mitomycin C as an adjuvant.

Reference

1. Noguera SI, Nicanor KSA, Ang RET. Clinical outcomes of pterygium surgery over a ten-year period: a review of recurrence and complication rates. BMC Ophthalmol. 2025. PMID 40596959

Frequently asked questions

No. Once formed, a pterygium does not regress spontaneously. Small and stable, it can simply be monitored ; only surgery can remove it when it becomes bothersome.

A small pterygium is mainly bothersome through irritation and appearance. When it progresses toward the center of the cornea, it can induce astigmatism and, more rarely, encroach on the visual axis : this is what justifies regular monitoring.

No. A stable, mildly bothersome pterygium can simply be monitored, with artificial tears and sun protection. Surgery is indicated in cases of visual discomfort, induced astigmatism, progression toward the central cornea, repeated inflammation or for marked cosmetic discomfort.

The procedure is performed under local anesthesia and is not felt during the operation. In the first few days, a foreign-body sensation and discomfort are common, relieved by eye drops ; they generally subside within one to two weeks.

Yes, this is the main challenge of this surgery. The excision technique with conjunctival autograft clearly reduces this risk compared with simple removal. UV protection after the operation further limits recurrences.

Beyond the surgical technique (conjunctival autograft), prevention relies on sun protection with anti-UV glasses, managing dry eye with artificial tears and avoiding dusty or windy environments.

Consultation & Surgery

Book a consultation for a pterygium

Assessment in Cachan. Surgery with conjunctival autograft at Clinique Sainte-Geneviève (Paris 14).

Cachan — Doctolib

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