Pterygium Surgery
A pterygium is a growth of tissue that develops on the surface of the eye, most often linked to long-term exposure to UV light and wind. It typically begins as a small, raised area on the white of the eye and can gradually extend inward, sometimes reaching far enough to grow onto the cornea (the clear, dome-shaped surface at the front of the eye that vision depends on). Pterygium excision with conjunctival autografting is the procedure used to treat it, and recurrence risk varies according to the surgical technique used, the characteristics of the pterygium and individual healing factors.
What Is Pterygium Surgery Used to Treat?
Pterygium surgery removes the abnormal tissue growing across the surface of the eye and from the cornea. The procedure also aims to reduce the risk of recurrence (the pterygium growing back after surgery) by covering the area with a conjunctival graft (a small piece of healthy tissue taken from another part of the same eye).
Removing a pterygium should be considered an absolute indication when it is growing toward the centre of the cornea. Relative indications, when removal may be considered, include persistent irritation or redness, changes to the shape of the cornea that affect vision, or significant concern about the appearance of the eye.
The Procedure
The pterygium tissue is surgically excised from the surface of the eye. A conjunctival autograft, a small piece of healthy conjunctiva (the thin, clear membrane covering the white of the eye) taken from elsewhere on the patient’s own eye, is then placed over the area and secured, either with fine sutures or with tissue adhesive (a medical-grade glue used in place of stitches).
In Plain Terms: The abnormal tissue is removed, and a small patch of the patient’s own healthy tissue from another part of the same eye is used to cover the area it was removed from. Using a conjunctival autograft helps reduce the risk of the pterygium returning compared with excision techniques that leave the underlying area uncovered.
A pterygium that is growing, particularly towards the central part of the cornea, must be removed as it risks affecting vision if left untreated. If it reaches the centre of the cornea, in front of the pupil, the scar remaining even after excision may reduce visual acuity.
Ongoing irritation, redness, or a persistent foreign-body sensation (the feeling that something is in the eye) caused by the pterygium
A cosmetic concern about the appearance of the eye, which is a valid and common reason patients seek treatment, alongside the physical symptoms
A pterygium already affecting the curve of the cornea enough to blur vision or distort a glasses prescription
Not every pterygium needs surgery. A small, stable pterygium that isn’t growing and isn’t causing symptoms is often simply monitored over time rather than treated, since surgery, like any procedure, carries its own risks and is only worthwhile once the pterygium itself has become the bigger problem.
Redness, mild discomfort and a gritty sensation are common during the first one to two weeks. The appearance of the eye may continue to improve over several additional weeks. Recovery varies according to the size of the pterygium, the surgical technique used and the individual healing response.
As with any ophthalmic surgical procedure, pterygium surgery carries potential risks and limitations. These may include recurrence, infection, bleeding, prolonged redness or discomfort, corneal scarring, delayed surface healing, graft displacement and the need for additional treatment. Less common complications may affect eye movement, the cornea or the sclera. The risks relevant to each patient depend on the characteristics of the pterygium and the surgical approach and are discussed as part of the informed consent process.
Not every pterygium needs to be removed. The decision depends on its size and position, whether it is growing towards the central cornea, whether it is affecting the shape of the cornea or vision, and how much irritation or other symptoms it is causing. The surgical technique also matters because the way the affected area is treated and covered after removal influences the likelihood of recurrence (the pterygium growing back).
Dr David Robinson has performed more than 100 pterygium procedures over more than 28 years of ophthalmic practice. During your assessment, he will examine the pterygium and the surrounding cornea, consider how it is affecting your eye, and explain whether monitoring or surgery is appropriate. If surgery is recommended, he will also explain what the procedure involves, the role of the conjunctival graft and what you can reasonably expect during recovery, so you can make an informed decision about your treatment.
Common Questions Patients Ask
Does a pterygium always need surgery?
No. A small, stable, symptom-free pterygium is often simply monitored rather than treated.
Can a pterygium come back after surgery?
It can, though this depends heavily on technique. Removing the tissue without a conjunctival graft carries a substantially higher chance of recurrence than removal combined with a graft, which is why the graft is considered standard practice.
Is the surgery painful?
Pterygium surgery is generally performed under local or topical anaesthesia. Patients may experience pressure or other sensations during the procedure, but not sharp pain. Irritation, a foreign-body sensation, or discomfort can occur during recovery. Severity and duration vary between patients.
Will a pterygium permanently affect vision if left untreated?
If it grows far enough to reach the central, visual part of the cornea, it can cause lasting blurring due to scar formation or astigmatism. Astigmatism (uneven, distorted vision caused by an irregular corneal surface) may occur even before the pterygium reaches the central cornea, which is why its growth pattern is worth monitoring over time, even before symptoms become bothersome.