Pterygium Treatment Program

Pterygium is a common, non-cancerous ocular surface condition characterized by the growth of fibrovascular tissue—a combination of fibrous connective tissue and abnormally proliferating blood vessels—originating from the conjunctiva and extending onto the cornea, most commonly on the nasal side. This tissue growth results from chronic alterations to the ocular surface environment, leading to a degenerative and hyperplastic response involving both stromal and vascular components. Often referred to as “surfer’s eye” due to its higher prevalence in individuals frequently exposed to sunlight and environmental irritants, pterygium can affect one or both eyes. Although benign in nature, the progressive expansion of the lesion can lead to structural changes in the cornea, inducing astigmatism or, in more severe cases, encroaching upon the visual axis and impairing visual acuity. In addition to functional disturbances, pterygium may also present cosmetic concerns, particularly when prominent. While many cases remain asymptomatic or stable, surgical removal becomes necessary when the lesion demonstrates progressive growth, causes significant discomfort, or compromises vision or corneal integrity.

Why Cuba

In Cuba, pterygium surgery is performed with exceptional precision by highly trained ophthalmic specialists, ensuring both clinical effectiveness and aesthetic satisfaction. The country’s medical excellence extends to ocular surface procedures, with surgeons utilizing advanced techniques to safely remove pterygial growths while preserving corneal integrity and minimizing recurrence rates. Given the potential of pterygium to affect visual acuity and ocular comfort, Cuban ophthalmology teams conduct comprehensive preoperative assessments to evaluate corneal involvement and determine the most appropriate surgical approach.

Cuba offers both traditional and minimally invasive techniques for pterygium excision, often incorporating conjunctival autografts or amniotic membrane transplantation to enhance healing and reduce the likelihood of regrowth. Postoperative care is carefully tailored, emphasizing anti-inflammatory management and ocular surface stabilization to ensure optimal recovery and long-term outcomes. With a strong focus on patient-centered care, Cuban medical institutions provide detailed follow-up and individualized support, making the country a trusted destination for high-quality pterygium treatment and comprehensive ocular rehabilitation.

Causes of Pterygium

Pterygium develops as a result of chronic irritation to the ocular surface, leading to abnormal proliferation of conjunctival tissue. Over time, the fibrovascular tissue grows toward and onto the cornea, potentially altering its curvature and affecting vision. While the exact mechanism is not fully understood, cellular changes associated with UV-induced DNA damage and oxidative stress are believed to play a central role in the condition’s development.

Several environmental and genetic factors contribute to the formation of pterygium:

• Prolonged UV light exposure, particularly UV-B rays.
• Dry, dusty, or windy climates, which cause chronic ocular surface irritation.
• Exposure to chemical or environmental pollutants.
• Genetic predisposition, especially in people from tropical and subtropical regions.
• Lack of protective eyewear during outdoor activities.

These risk factors lead to degenerative and inflammatory changes in the conjunctiva, triggering the abnormal growth of tissue onto the cornea.

Symptoms of Pterygium

While many pterygia remain small and asymptomatic, progressive or large pterygia can have several negative impacts with symptoms varying depending on the size and activity of the lesion:

• Visual distortion: The growth can induce astigmatism by pulling on the corneal surface, leading to blurred or distorted vision.
• Obstruction of vision: In advanced cases, the pterygium may grow into the visual axis, directly impairing sight.
• Ocular discomfort: Redness, irritation, and a gritty or burning sensation are common.
• Chronic inflammation: Repeated inflammation can exacerbate symptoms and increase the risk of recurrence after removal.
• Foreign body sensation or eye irritation: Caused by the raised, uneven surface of the pterygium rubbing against the eyelid or cornea, leading to discomfort or a gritty feeling.
• Dryness and tearing: Disruption of the tear film and chronic inflammation can lead to a sensation of dryness, often paradoxically accompanied by excessive tearing.
• Sensitivity to light (photophobia): Growth can alter corneal smoothness and surface integrity, making the eye more sensitive to sunlight or bright environments.
• Cosmetic Concerns: Visible growth can affect appearance and self-confidence.

Types and Classification of Pterygium

Pterygia can be classified by location, appearance, and severity:

Based on Location:

• Nasal Pterygium: The most common form, originating near the nose.
• Temporal Pterygium: Less common, growing from the outer (temporal) side of the eye.
• Double Pterygium: Present on both nasal and temporal sides of the same eye.

Based on Clinical Appearance:

• Atrophic: Thin and non-inflamed, with visible underlying blood vessels.
• Fleshy: Thick, red, and vascularized, often indicating active inflammation and greater likelihood of progression.

Based on Severity:

• Grade I: Limited to the limbus (edge of the cornea).
• Grade II: Extends onto the cornea but does not affect vision.
• Grade III: Approaches or involves the central visual axis, posing a significant risk to visual acuity.

Diagnosis of Pterygium

Diagnosis is typically clinical and involves a detailed eye examination:

• Slit-lamp biomicroscopy to assess the lesion’s size, depth, and vascularity.
• Visual acuity testing to detect refractive changes caused by astigmatism.
• Corneal topography to evaluate corneal shape and determine if the pterygium is affecting vision.
• Anterior segment OCT (optional) for precise imaging of tissue involvement.
• In some cases, differential diagnosis is necessary to rule out other ocular surface tumors or lesions.

Types of Procedures and Surgical Approaches

Pterygium can be effectively managed through various surgical approaches designed to remove the growth, restore ocular surface integrity, and minimize the risk of recurrence.

Surgery may be recommended for:

• Patients with progressive pterygium encroaching on the cornea.
• Individuals experiencing significant discomfort, redness, or irritation unresponsive to conservative treatment.
• Cases where pterygium is causing astigmatism or visual distortion.
• Patients with cosmetic concerns or recurrent inflammation.

Surgery may not be recommended for:

• Patients with mild, asymptomatic lesions not affecting vision.
• Individuals with active ocular infections or poor ocular surface health.
• Patients with systemic conditions that impair healing or increase surgical risk.
• Individuals unable or unwilling to comply with postoperative care instructions, increasing recurrence risk.

Pterygium Treatment

• Pterygium Excision with Conjunctival Autograft (Minimally Invasive)
  • The most effective and widely used technique.
  • Involves removing the pterygium and replacing it with a graft of healthy conjunctival tissue from the same eye.
  • Graft is secured using sutures or fibrin glue.
  • Low recurrence rate and quick healing make it the preferred approach.

• Amniotic Membrane Transplantation
  • Used when conjunctival tissue is unavailable or insufficient.
  • Provides anti-inflammatory and healing properties.
  • Commonly combined with adjunctive therapies to reduce recurrence.

• Bare Sclera Technique
  • Pterygium is removed and the underlying sclera is left exposed.
  • Higher recurrence rate; rarely used today unless as a temporary or emergency measure.

• Adjunctive Treatments:
  • Mitomycin C (MMC): Applied during surgery to inhibit fibroblast proliferation and reduce recurrence.
  • Postoperative anti-inflammatory eye drops: Help control inflammation and promote healing.