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PTERYGIUM
PREPARED BY : FARHUDA ZULAIKHA BT DOL @ ABDUL
WAHIDDURATUL’AIN BT MOHD NAZRI
NURUL NAJUWA BT SAZALI
PTERYGIUM1) DEFINITION2) ETIOLOGY3) PATHOLOGY4) CLINICAL PICTURE (Signs & Symptoms,
course)5) DIFFERENTIAL DIAGNOSIS6) TREATMENT
1) DEFINITION
Most often refers to a benign growth of conjunctiva
It grows from the nasal side of sclerapterygium is a fleshy growth that invades the
cornea (the clear front window of the eye). It is an abnormal process in which the conjunctiva (a membrane that covers the white of the eye) grows into the cornea.
2) ETIOLOGY
Unknown but may related to :a) Ultraviolet rays (most important factor)
-engaging in occupations that require outdoor activity
b) Chronic irritation by dust etcc) Genetic predisposition
-development of pterygium appear to exist in certain families
3) PATHOLOGY
Pterygium consists of:- Degeneration of collagen-Fibro-vascular proliferation (fibrous tissue + blood vessels)-overlying covering of epithelium (thin layer)
• Symptoms
Persistent redness Inflammation FB sensation
Dry eyes Itchy eyes Cosmetically disfigurement
Potential of induced
astigmatism
Corneal scarring
Vision affected (if it reaches
central part of cornea)
• SignsAPEX : blunt and lies over the cornea and may grow to reach papillary area(affects vision)
NECK : Overlies the limbus
BASE : Lies over the sclera
Site : On the nasal side less commonly temporal and always bilateralShape : Is triangular and consists of apex, neck & base
• Course
A) PROGRESSIVE B) STATIONARY
Thick and fleshyVascularPreceded by white dots
Thin and membranousLess vascular
5) DIFFERENTIAL DIAGNOSISA- Neoplasia
# carcinoma in situ of conjunctiva and cornea. Also known as Bowen’s disease.# squamous cell carcinoma# other neoplastic diseases
B- Pannus
C- Pingueculae
# commonly occurring, generally small and asymptomatic# occasionally be subject to some inflammation with symptoms of itching, burning, or mild pain# mild-to-moderate focal thickening of the conjunctival stroma with elastotic degeneration of collagen
Difference
PTERYGIUM PSEUDO-PTERYGIUM
Nature Degenerative condition
A fold of conj, attached to the base of a healed corneal ulcer.
Site Bilateral-on nasal side
Unilateral- anywhere
Hook Cannot be passed under the neck
Can be passed under the neck
Course Progressive or stationary
Always stationary
D.D of Pterygium & PingueculaeDiff. Pterygium Pingueculae
Nature Degenerative condition Degenerative condition occuring in old people
Shape Triangular which the apex lies over the cornea
Triangular nodule with base towards the cornea
Color Reddish white (fibrovascular tissue)
Yellow (raised)
Site Nasal sideAlways bilateral
Nasal side
Pathology Conjunctival epithelium (thin layer)
+Fibro-vascular tissue
+Destroyed: Bowman’s layer & sup. layer of stroma
Hyaline degeneration (of conjunctiva)
+Elastic tissue deposition
6) TREATMENTPterygium is best left alone
- if small & stationary- recurrence may follow the operation
Indications of operations :# progressive# if it encroaches pupillary area# if patient is annoyed (cosmetic reason)
NON SURGICAL1) Eyedrops for irritation and redness.2) Protection from sunlight and dust to prevent it from wosening3) Steroids to lessebn inflammations
Operation for pterygium(1)Excision + bare sclera
technique pterygium is removed
leaving a raw area of sclera (this allows corneal
epithelium to cover the cornea before conjunctival epithelium reaches the limbus)
(2)Excision + application mucous membrane,conjunctival or coeneal graft
- gap in the mucous membrane (conjunctiva) tissue, where the pterygium was removed, is filled with a transplant of tissue that has been painlessly removed from underneath the upper eyelid.
PREVENTION OF PTERYGIUMWearing protective sunglasses with side
shields and/or wide brimmed hats (as it is associated with excessive sun or wind exposure)
Using artificial tears (prevent their formation/stop further growth
Surfers & water-sport athletes:- wear eye protection (block 100% of UVR from water)
MEASURES USED TO PREVENT RECURRENCE :Expose the bare area to Beta irradiation.Expose the bare area to Mytocin CExcision & mucous membrane grat.Excixion & lamellar (structural) keratoplastyStem cell transplantation