Let's talk about pterygium. Is this a problem for you too?

Have you ever noticed a small fleshy lump that protrudes from the corner of your eyeball into the middle of your eye? It may be pink, or it may have tiny blood vessels. This is what our ancestors called a "papillary" and doctors call it a "Pterygium". Some people also call it "Surfer's Eye" because it is commonly seen in surfers. Let's talk about it in more detail today, because while this may be a minor problem for some people, it can be a serious problem if you are aware of it.

What is this pterygium?

Simply put, a ``Pterygium'' is a raised, fleshy membrane that forms on the white part of your eye (which we medically call the ``Conjunctiva''). Think of it like a small piece of membrane that has come off your eye. It can be white or pink. Sometimes it has tiny blood vessels, which is why it sometimes looks red.

It usually starts in the corner of the eye, most often on the side of the nose. Then it grows towards the iris (the colored part of the eye - doctors call it `(Iris)`). Most of the time, it is triangular in shape, like a bird's wing. The word `(Pterygium)` comes from two Greek words; one `(pteryx)` meaning ``wing'', and the other `(pterygion)` meaning ``shore''. So the name itself gives a little idea of ​​the shape.

Who is more likely to develop this membrane?

As the name ``Surfer's Eye'' suggests, this condition is more common in surfers. The reason for this is that they are constantly exposed to things that can cause this film to form – such as harsh sunlight, strong winds, sea sand, and salt water .

But, it's not just for surfers. Anyone who spends a lot of time outdoors without any eye protection can develop this. This risk is especially high for people in our country like farmers, fishermen, road workers, and construction workers. Because their jobs require them to spend most of the day outdoors, exposed to these environmental factors.

This condition is more common as people age (especially after the age of 60) due to prolonged exposure to these environmental factors. It is also more common in people living in countries near the equator, where sunlight is very intense.

Is this dangerous?

Now you may be wondering if this is something dangerous like cancer. No, this `(Pterygium)` is not `(cancerous).` That means it does not spread to other tissues inside the eye, nor does it go to other parts of the body.

However, the problem is that it can continue to grow along the surface of the eye. If it somehow reaches the transparent part of your eye (we call it the `(Cornea)`) above the black ring, that is, if it reaches the middle of the eye, it can damage your vision. It can cause blurred vision, you can't see clearly. If that happens, you may have to have it removed `(surgery)`.

Why does this membrane form? What are the causes?

Pterygium is actually an unwanted growth of the conjunctiva tissue in your eye. The main causes of this are:

• Prolonged exposure to harmful ultraviolet rays (`(Ultraviolet - UV light)`) from the sun. This is considered the main cause. We know that UV rays are not good for the eyes.
• Chronic irritation of the eyes caused by things like hot, dry weather, strong winds, and dust . Imagine, if dust constantly gets into the eyes, if the eyes dry out, it will always cause trouble for the eyes.

In addition to this, there may be several other risk factors:

• Being over 60 years of age (as mentioned before).
• Genetics: This means that if someone in your family has it, you have a small chance of developing it too.
• Vitamin A deficiency.
• Human Papilloma Virus (HPV) infection. (This is still in the research stage and has not been confirmed.)

What are the symptoms of this?

At first, you may not even realize you have a pterygium. You may just notice a raised, fleshy, wedge-shaped lump in the corner of your eye. It may not be a problem at all.

But when symptoms do appear, they can be a bit bothersome. Some common symptoms include:

• Swelling and redness of the eyes (sometimes a condition called `(Conjunctivitis)` can occur).
• Red eyes, blood vessels clearly visible.
• Feeling of dry eyes (`(Dry eye)`).
• Watery eyes (could actually be due to dry eyes).
• A feeling as if there is something inside the eye, like dirt, dust, or a grain of sand.
• Itchy eyes.
• Eye irritation.
• Sometimes the eyes hurt.

Over time, as this membrane grows larger, other symptoms may appear:

• You can see that membrane growing in size and spreading throughout the eye.
• If you wear contact lenses, you may experience difficulty inserting them, pain, or the lenses not fitting properly.
• Changes in vision. For example, blurred vision, sometimes double vision.

Remember, not everyone will have all of these symptoms. Some people's membranes grow faster than others, and some people's are very slow.

What is the difference between a pterygium and a pinguecula?

You may have heard of a `(Pinguecula)` (pin-ge-ku-la). It is also a different type of lump that forms on the white part of the eye. The causes are largely the same as `(Pterygium)` – namely environmental factors, especially prolonged exposure to sunlight. However, `(Pinguecula)` is much more common than `(Pterygium)`. Sometimes a `(Pinguecula)` starts out as a `(Pinguecula)` and later becomes a `(Pterygium)`.

Now let's see what are the main differences between a `(Pinguecula)` and a `(Pterygium)`:

• A pinguecula is a small, wedge-shaped bump, similar to a blister. A pterygium spreads like a wing.
• A pinguecula does not spread above the cornea. It is located on the white part of the eye.
• The color of `(Pinguecula)` is also yellowish white rather than pink.
• It doesn't have fleshy tissue or blood vessels. It may contain things like protein, fat, calcium, etc. `(Pterygium)` has fleshy tissue and blood vessels.
• Pinguecula often causes very few symptoms or eye problems.
• It is very rare that an operation is needed to remove it.

How does a doctor recognize this?

Your eye care provider can easily identify a pterygium during an eye exam. They typically use a test called a slit lamp exam. A slit lamp is a special microscope that shines a bright beam of light (like a slit lamp) into your eye to look at the front and inside of your eye. This is part of a routine eye exam. Your doctor can tell right away that it's a pterygium. No other tests are usually needed.

What are the treatments?

Treatment for pterygium depends on how much it affects you.

• If there are no symptoms: You probably won't need treatment. But your eye doctor will keep an eye on it. They will ask you to come in for eye exams at regular intervals (maybe once a year) to see how the cataract is growing and whether it's affecting your vision.
• If you have eye problems: If a pterygium irritates your eyes, such as redness, itching, or burning, your doctor may prescribe:
• Over-the-counter (OTC) eye drops or eye ointments can be purchased at the pharmacy without a prescription. These can help reduce dry eyes and inflammation.
• If the symptoms are severe, steroid eye drops can be given for a short period of time. These can quickly reduce swelling and redness. However, these should only be used under medical advice.

Also, doctors recommend wearing a hat and sunglasses with `(UV protection)` that cover both eyes . This will help prevent further `(UV)` damage to your eyes. This may help your `(Pterygium)` from getting bigger, or at least stop it from getting bigger as quickly.

Do I need to have surgery?

Not all pterygiums require surgery. However, your doctor may recommend eye surgery in the following cases:

• If you have an eye problem that cannot be controlled with things like eye drops (inflammation, pain, redness).
• If a `(Pterygium)` grows rapidly, approaches the cornea, and obstructs or is about to obstruct vision.
• If the shape of the eye has changed due to a pterygium and vision problems such as astigmatism have occurred.
• Some people decide to have it removed for cosmetic reasons, because for some people, having a red eye and a discharge can also affect them psychologically.

How is the surgery performed?

An eye surgeon (Ophthalmologist) can remove a pterygium. If you don't have one, your optometrist can refer you to one.

During the `(Pterygium)` operation, your eye surgeon will do the following:

1. Numbness: First, you will be given a numbing medicine (`(Anesthesia)`). This may be in the form of eye drops or a small injection. So you will not feel any pain.

2. Removing the membrane: The surgeon then carefully removes the abnormal tissue (pterygium) from the surface of the eye.

3. Closing the gap: After the membrane is removed, a small gap is left in the `(Conjunctiva)`. Surgeons use various methods to close this gap. This is important to reduce the risk of `(Pterygium)` forming again.

• Conjunctival autograft: This is a very successful procedure. Your surgeon takes a piece of tissue from another healthy part of your eye (usually under the upper eyelid, where the tissue is better) and closes the gap. This is like putting on a patch. This procedure creates a small wound under the eyelid, but it is well protected there and heals on its own.
• Amniotic tissue graft: This involves using a special tissue (`(Amniotic membrane tissue)`) taken from donated fetal membranes (i.e., the placenta) to close the gap until it heals. This tissue acts like a natural bandage, protecting the gap until the `(Conjunctiva)` grows back and closes. This method is useful if the gap is larger than an `(autograft)`, or if an `(autograft)` is difficult to obtain.

Pterygium surgery usually takes about an hour. After the surgery, you will need to wear an eye patch for a few days. It will take about four to six weeks for the eye to fully heal. During this time, the eye may be red and may feel a little uncomfortable.

The doctor will prescribe medication for you to take home. This may include antibiotic drops or ointment to prevent infection and steroid eye drops to prevent the pterygium from coming back. It is very important to use this medication correctly and for the prescribed period.

Are there any risks to the operation?

As with any operation, there may be some risks involved in a ``(Pterygium)`` operation.

• The main risk is recurrence – that is, the pterygium comes back after surgery. If that happens, another surgery may be necessary. Fortunately, with new and improved surgical techniques such as conjunctival autograft, the rate of pterygium recurrence has decreased significantly. According to current research, the risk of recurrence is between 2% and 15% with a good surgeon and good technique.
• If you do not use the prescribed eye drops correctly, or if your eyes are exposed to direct sunlight after the operation, the chances of recurrence are high. It is very important to follow your doctor's instructions exactly. You can go outside, but if you do, don't forget to use protection such as a hat and sunglasses.
• Sometimes, medications used to prevent recurrence can also cause side effects. For example, antimetabolites such as Mitomycin C (which are sometimes used to prevent recurrence) can cause the sclera to thin (scleromalacia) after pterygium surgery. Long-term use of steroid eye drops can increase eye pressure or cause cataracts. This is why they should be used only under medical supervision.

What happens if this membrane is not removed?

Most `(Pterygia)` (that's the plural of `(Pterygium)`) continue to grow, but some grow much larger than others. Your `(Pterygium)` may never cause you any major problems. Doctors do not recommend surgery for small, asymptomatic `(Pterygium)` because of the risk of recurrence.

However, a pterygium that continues to spread throughout the eye can cause problems.

• This can cause constant eye discomfort, redness, and increased inflammation.
• Vision may become unclear or blurry.
• If it somehow gets on the cornea, it can stretch the cornea, change its shape, and cause a condition called astigmatism. This can further impair vision.
• It can also cause scarring of the cornea, which can have a permanent effect on vision even after the membrane is removed.

What can be done to reduce the occurrence of this?

"Prevention is better than cure." So, to reduce the risk of developing a `(Pterygium)`, and to prevent it from getting bigger if you have one, you can do the following:

• The most important thing is to protect yourself from the sun. When you are in the sun, especially between 10 am and 4 pm, wear wraparound sunglasses with good UV protection.
• Wear a hat or cap. This will also reduce the amount of sunlight that hits your eyes.
• If you are working in a dry, windy, or dusty environment, wear protective eyewear.
• If your eyes feel dry, use eye drops (such as artificial tears) (as directed by a doctor) to keep your eyes moist.

How long does a pterygium last? Will it come back if it is removed?

A ``(Pterygium)`` will not get better on its own unless it is removed by a surgeon. It can continue to grow throughout your life. However, this does not happen to everyone, and some people may only have one size for a while.

Most people don't need treatment for a ``(Pterygium)''. If it's causing eye discomfort, you can usually control the symptoms with over-the-counter medications. If it's more than a minor nuisance, you can have it removed.

There is a small chance that your `(Pterygium)` will come back after surgery. If it does, it will usually start to appear within four months of the surgery, and no later than 12 months. If you do have to have another surgery, your surgeon will take extra steps to prevent the `(Pterygium)` from coming back.

When should I see a doctor?

If you think you have a `(Pterygium)`, or if you notice something new in the corner of your eye, the first thing you should do is see an ophthalmologist. Then you can know for sure whether it is a `(Pterygium)` or something else.

Your doctor will want to see you regularly, check your pterygium, and measure its growth – usually once a year, unless it is growing faster or larger than normal.

In cases like these, don't forget to see a doctor first:

• If new symptoms begin to appear (e.g., vision changes, eye pain).
• If your current symptoms worsen.
• If the medications you are currently taking don't seem to be working properly.

A `(Pterygium)` can be a bit scary when you first see it, but you'll soon realize that it's not that serious. You may never need treatment for it. If it causes symptoms, you can control them with over-the-counter medications or eye drops. Your doctor will keep an eye on it and let you know if they recommend removing it.

Take-Home Message

Okay, so, here are some of the most important things you need to remember from what we've talked about:

• A pterygium is a non-cancerous, flesh-like growth that forms on the white part of the eye.
• The main cause is prolonged exposure to sunlight (UV rays), dust, and wind.
• Symptoms may include redness, itching, burning, a feeling of something stuck in the eye, and possibly blurred vision.
• Not all of them require treatment. However, if they affect vision or are very bothersome to the eye, they can be removed with surgery.
• The most important thing is to use sunglasses, wear a hat, and take care of your eyes. This can help prevent them from forming and control the growth of existing ones.
• If you have these symptoms, don't be afraid to see an ophthalmologist and get advice. Then you can find out what's best for you.

So, eyes are a very precious thing. Therefore, it is our responsibility to take good care of them.

` Papilloma, Conjunctiva, Pterygium, Surfer's Eye, Eye Diseases, Eyesight, Sunlight