What is a pterygium?

A pterygium is a raised, triangular or wedge-shaped, benign growth of conjunctiva tissue. The conjunctiva is the mucus membrane that covers the front of your eye. It usually occurs on the side of your eye nearest your nose.

A pterygium can grow over the cornea (the transparent dome at the front of your eyeball) in a triangular fashion. It may grow large enough to affect your vision (eyesight).

What causes a pterygium?

A pterygium usually develops if you have been living in a hot, dry climate. This may be a response to: • your eye’s long-term exposure to sunlight and • chronic eye irritation from the dry climate

What are the symptoms?

Symptoms include: • irritation • redness • tearing (eyes watering). As the pterygium develops it may alter the shape of the cornea, making it curve more. This causes astigmatism, which affects how your eye focuses. When the pterygium has grown towards the centre of your cornea it will affect your vision.

How is it diagnosed?

The ophthalmologist (eye doctor) will be able to see the pterygium, just by looking at your eye.

How can it be treated?

Treatment depends on the symptoms. If the pterygium is small and/or growing, you may be prescribed eye drops or ointments to relieve any redness or irritation. You may be advised to have an operation to remove the pterygium if it becomes troublesome. For example, when: • it is causing constant eye irritation • it is causing problems with your vision • you are unhappy with how it affects your appearance.

What happens if I do not get treatment?

It is unlikely that the pterygium will get worse if you are living in the UK. If you are planning to move to a hotter, drier climate then it could get worse. Surgery is the only way to remove the pterygium.

What are the benefits of surgery?

An operation to remove the pterygium will reduce the symptoms, such as eye irritation. It can also improve your vision and the appearance of your eye.

What are the risks?

•The main risk is that the pterygium will regrow. This happens in five to 10 people out of every hundred. If this happens you may need to have it removed again.

•There is a risk of infection, but this can be treated. There is a risk of scarring to your eye. This will be explained to you before you agree to have the procedure.

Will I need an anaesthetic?

The operation can either be performed using a local or a general anaesthetic. A local anaesthetic is a medicine which numbs a specific part of your body so it is pain free. A general anaesthetic is a medicine that will make you unconscious (asleep) throughout the procedure. It is given through a small injection in the back of your hand. A specially trained doctor called an anaesthetist will stay with you and monitor you during your surgery.

How can I prepare for surgery?

If you are having a local anaesthetic, you do not need to do anything to prepare.

If you are having a general anaesthetic you should follow the instructions about fasting (not eating or drinking) before your operation that we will give you.

If you have food and drink in your stomach when you have the anaesthetic you have a higher chance of being sick while you are unconscious. This could lead to complications.

Your appointment letter will tell you where to go and what time you need to be there.

Asking for your consent?

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

What does the surgery involve?

A nurse will put an anaesthetic drop into the eye which is being operated on. The operation involves removing the conjunctival tissue over the cornea. To try and prevent the pterygium regrowing, this is often combined with the grafting of a free flap of adjacent conjunctiva over the bare area of the white of the eye (sclera). Some surgeons also use a chemical called Mitomycin-C to help prevent the pterygium from regrowing. This is dabbed onto your eye. If your surgeon is planning to use Mitomycin-C, this will be explained fully to you before you sign the consent form. The surgery usually takes about 20 to 30 minutes.

The use of Mitomycin-C for this condition is unlicensed. This means that although the manufacturer of the medicine has not specified it can be used in this way, there is evidence that it may be of benefit. Further information on unlicensed medicines is available in our leaflet Unlicensed medicines – a guide for patients – please ask your doctor, nurse or pharmacist if you would like a copy.

Will I feel any pain?

You may feel a little pain when you are given the anaesthetic injection, but then the operation should be pain-free.

What happens after the operation?

You will be taken back to the ward where the nurses will look after you. They will give you painkillers if you are in any pain.

When can I go home?

If you had a local anaesthetic, you should be able to leave the hospital straight away. If you had a general anaesthetic, you will need to stay in hospital until you have fully recovered from the effects of the anaesthetic. This will probably be about three to four hours. During this time, the nurses will monitor your progress. You will also be given a drink and some food. You will need to have someone to accompany you home whether you have had a local or a general anaesthetic.

What do I need to do after I go home?

You will have a pad covering your eye which you will need to leave in place for 24 hours. You will be given an appointment for the day after your surgery to come back to hospital and have the pad removed. Your eye will probably feel sore for about three to seven days after the operation. You will be prescribed antibiotic and steroid eye drops to use for a few weeks after surgery, once the pad is removed. Your eye will be red for about six to 12 weeks, and then this will settle.

If you usually wear contact lenses, the eye specialist will tell you when you can start to wear them again. If you had a general anaesthetic, it is important that you follow the advice below for your safety. Although you might feel fine, your reasoning, reflexes, judgement, coordination and skill can be affected for 48 hours after your surgery. Please rest at home for at least 24 hours after the surgery. Do not go to work or school on the day after your surgery. Please follow the advice and instructions that the doctors and nurses have given to you.

For 48 hours after the surgery, please do not:

Will I have any follow-up appointments?

You will need to come back into hospital the day after your operation so we can check on your recovery and remove the pad covering your eye. You will then be given an appointment for one month after your surgery and another for three months after surgery.

Is there anything I need to look out for at home?

Occasionally you could get an infection in the eye. This will cause redness and pain. If this happens you should call the eye department.

When can I resume my normal activities?

You should be able to go back to work within a few days, as long as you feel well enough. You can bathe or shower as normal, but you should avoid swimming for two weeks. This is because of a risk of infection.