Dry eye pinguecula and pterygium are two eye conditions that can occur as a consequence of prolonged dry eye irritation, but there are also additional factors that can explain their occurrence. This blog post discusses the causes, symptoms and treatments of pinguecual and pterygium.
The question if dry eye can cause permanent damage to your vision, eye or surface of the eye is often asked by dry eye sufferers. When your eyes are irritated for a prolonged period of time the question is of course relevant to ask. There are no fixed time periods for when the risk increases or becomes especially problematic. Generally, you should of try to treat your dry eye symptoms as quickly and efficiently as you can. I have described how to start a dry eye treatment in previous posts.
Two conditions that can arise as a consequence of prolonged eye irritation are pinguecula and pterygium. These conditions are very similar so it is not uncommon that they are mixed up.
A pinguecula is a thick surface growth along the sclera (the white area) of the eye near its borders with the cornea. The growth is elevated slightly and white to yellow in colour. The pinguecula usually forms in the palpebral fissure (the surface area dividing the upper and lower eyelids). It is less transparent than healthy conjunctiva (the mucous membrane coating the inner eyelid surface and the white of the eye), has a fatty appearance, and is more likely to be located on the nose (rather than the ear) side of the eye.
Pterygium is a triangular, wing-like lesion that encroaches onto the cornea, usually near the nose and in the area continuous with the conjunctiva. It can be detected by its head — an elevated, whitish, opaque tissue on the cornea. Though generally not sight-threatening, severe pterygium can cause corneal blindness.
A pinguecula and pterigium are similar in tissue structures. A pinguecula is distinguishable from a pterygium by its location relative to the cornea and the horizontal orientation of its affected tissues. However, a pinguecula can become a pterygium when it crosses over onto the cornea.
It is not entirely known what causes pinguecula and pterygium but it is relatively certain that both diseases are strongly associated with chronic, long-term exposure to both blue and ultraviolet light. It is not coincidental that they are often located around the apex of the cornea, which is the area with greatest exposure to sunlight. The cornea and conjunctiva suffer cellular damage from exposure to ultraviolet radiation, especially with depleted levels of protective substances such as glutathione and astaxanthin. Due to the fact that these conditions can be caused or worsened by direct sunlight it is recommended that any dry eye sufferer is diligent in wearing protective sunglasses.
Pinguecula is also associated with increasing age. Pingueculae are present in most eyes by age 70 and in nearly all eyes by age 80. This is probably due to progressive degeneration of the conjunctiva, as a result of aging, past inflammations, chronic irritation, and dryness of the eyes.
Pterygium has been closely associated with patients living at latitudes of 37 degrees north and south of the equator — which tends to reinforce the association with UV-light exposure. Some links to hereditary factors have been described. Infection with the human papilloma virus has also been suggested as a cause.
Like pinguecula, pterygium is thought to develop from exposure to dust, low humidity (which can lead to increased tear evaporation and dry eyes), and microscopic damage from particulate matter in the air such as smoke and sand.
Though pterygium is often viewed as a chronic degenerative disease, some of its behavioural features suggest a proliferative growth disorder — rather like some benign tumours. After surgical removal, pterygia have exhibited a strong and aggressive tendency to recur.
Pingueculae usually don’t cause any serious problems. You may get a foreign body sensation from an irritated pinguecula. Extremely dry conditions and other environmental factors can cause inflammation and swelling.
You usually will not feel any symptoms from pterygium. Swollen and inflamed pterygia may cause foreign body sensation and some concerns about how your eyes look. Enlarged or more advanced pterygia, however, can induce astigmatism as it exerts pressure on your cornea.
Inflammation in the pinguecula responds well to treatment with non-steroidal anti-inflammatory drugs or, if necessary, topical corticosteroids. The associated dry eye symptoms can be addressed with eye drops. As mentioned earlier in this article, using sunglasses is highly recommended. Surgical removal of a pinguecula is rarely necessary. If you are considering removing a pinguecula you first need to familiarize yourself with the different types of procedures available. Due to the risk of re-growth some type of procedures are more preferable than others.
A small but inflamed pterygium may be treated with topical corticosteroids to suppress the inflammation. Dryness in the eye may be treated with prescription- or over-the-counter eye drops.
Large pterygia may require surgical removal. The excision procedure is easy. Preventing recurrence is difficult though.
If you would like effective and actionable advice on how to treat dry eyes and pinguecula then go here: dry eyes shop.
As always, please write your thoughts, comments and own experiences below.
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