Pterygium in eyes

I am suffering from pterygium. I have undergone an operation, but when the problem did not end, another doctor informed me that it recurs in 30% of the patients and I am one of them. My eyes, especially the right one, waters and there is burning sensation while I am working on the computer. I am using Itone, an Ayurvedic preparation of eye-drops, which seems to be giving some relief. I have been told that even a second operation would not give me relief, as the pterigium would re-grow. Is there any permanent cure for pterygium? I have used Refresh Tears to no avail. Is there a cure for these problems in any of the medical systems?

 

Thank for your letter about your pterygium, which, disappointingly, has recurred after surgical removal. It is a distressing disorder, which is not uncommon in India and in other countries which receive a high exposure to sunlight.
Pterygium is a condition of the conjunctiva, the moist lining tissue which covers the internal surface of the lids and white sclera of the eyeball. The word pterygium means a wing and the term refers to a wing-shaped triangle of tissue which grows from the exposed wedge of conjunctiva at the inner angle of the eye onto the surface of the cornea, the window of the eye. This patch of conjunctiva may give rise to symptoms of inflammation and irritation, or sometimes, if it grows excessively onto the cornea, it may threaten vision. These are two, good indications for surgical removal.
Pterygium probably has many causes, including chronic exposure to windy and dusty atmospheres, but the must important factor leading to its occurrence, is exposure to high levels of ultraviolet radiation, contained by intense sunlight. This is why the condition is commonest in those parts of the world with the highest levels of sunlight exposure, such as India and Pakistan, the Middle East, Australia.
The condition is confined to the region of the inner angle of the eye, because the anatomy of the eye, the manner in which the eye sits in the orbit, and the way we tilt our heads when exposed to sunlight, favour the ultraviolet radiation to be funnelled from the outer angle of the eye to the inner angle, where it is concentrated and can have its damaging effect. This stimulates inflammation and growth of the conjunctiva.
Although the symptoms of pterygium can be relieved to a some extent, by anti-inflammatory drops or by tear substitutes, these have little or no effect on the progression of the disorder, which tends to take its own course. Therefore surgery is a frequent method of treatment. Surgery consists of removing the pterygium tissue, and allowing the conjunctiva to heal while treating, for a limited period, with an antibiotic and an anti-inflammatory drop, such as a steroid. There are a great many surgical approaches which have been used in the treatment of pterygium, and none of them is free of the risk of recurrence of the original condition. However, two approaches are in particular favour at the present time, and appear to offer a lower risk of recurrence than techniques used in the past.
The first technique is excision of the pterygium, carried out at the same time as an autologous conjunctival transplant.(Autologous means that the transplant tissue is taken from the patient themself.) With this surgery, the pterygium tissue is removed in the usual way, and the defect left by the excision is filled by a patch of the patient's conjunctiva (the transplant) taken from a region of the eyeball under the upper lid. The transplant heals in position and appears to block the ingrowth of fresh pterygium tissue. The conjunctival defect under the lid heals naturally over a few weeks. This approach has greatly reduced the frequency of recurrences, although they can still occur.
In the second technique, the pterygium is removed in the usual way, and the bed of the pterygium is treated with a potent agent (usually mitomycin C)which inhibits subsequent fibrovascular growth and reduces the risk of recurrence. The agent is applied with a sponge for a few minutes, before being irrigated thoroughly away. Careful attention to the concentration of mitomycin used and the duration of application, has greatly reduced the risks of this kind of surgery, and this type of surgery too, has greatly reduced the risk of recurrence. This approach can be used for the treatment of recurrence itself.
Coming back now to your own problem, I am not of course aware of the kind of surgery which you had originally or of whether both eyes received treatment, but the best action to take now would be to return to your ophthalmologist, telling him or her about your fresh problems and asking whether they can help further. If they recommend reoperation, then it would be advisable, in additon to any measures which your physician recommends, to purchase spectacles which will reduce the exposure of your eyes to ultraviolet radiation after the surgery. Such spectacles should be designed not only to cut out the transmission of ultra-violet radiation through the spectacle lenses, but to provide suitable wrap around side pieces which prevent reflected and scattered ultraviolet radiation from impinging on the eyes from the sides.