Pterygium (Surfer's Eye)

Pterygium is a benign fibrovascular proliferation of the bulbar conjunctiva that grows in a wing-like shape onto the cornea, typically at the 3 o'clock or 9 o'clock position (more commonly nasal). It is highly prevalent in equatorial regions, in outdoor workers, and in those with chronic UV exposure—giving rise to the colloquial term 'surfer's eye.' Pathogenesis involves UV-induced damage to limbal stem cells, altered tear film, dry environments, dust exposure, and elastotic conjunctival degeneration. The lesion typically progresses slowly but can cause induced astigmatism, visual axis encroachment, and chronic inflammation. Pingueculae (yellowish conjunctival deposits without corneal extension) are precursor or related lesions.

Clinical features include redness, foreign-body sensation, tearing, irritation, and cosmetic concerns; advanced lesions cause significant astigmatism and threaten the visual axis. Examination shows a fibrovascular triangular growth with cap, head, and body extending from conjunctiva onto cornea, with iron deposits (Stocker's line) at the leading edge in chronic lesions. Differential diagnosis includes pseudopterygium (post-trauma adhesion), conjunctival intraepithelial neoplasia (CIN), squamous cell carcinoma, and amelanotic melanoma; biopsy is indicated for atypical lesions.

Management is conservative for asymptomatic, non-progressive lesions: UV-protective sunglasses, hat use, lubricating drops, topical NSAIDs or low-dose steroids for inflamed pterygia. Surgical indications include visual axis threat, significant astigmatism (>1 D), persistent inflammation, restricted ocular motility, or cosmetic concerns. Surgical techniques have evolved: bare sclera excision (high recurrence 40-80%) is now obsolete; conjunctival autograft (CAG) with fibrin glue or sutures is the gold standard with recurrence under 5-10%; adjuvant mitomycin C (intraoperative or topical postoperative) reduces recurrence further; amniotic membrane transplantation is an alternative for large defects. Postoperative care includes topical steroids, antibiotics, and lubrication for several weeks; serial follow-up monitors for recurrence.