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Pingueculum & Pterygium

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Overview

Pingueculum

This is a slight thickening of the conjunctiva usually at 3 and 6 o’clock on the conjunctiva. They are usually bilateral, and do not grow on to the cornea. Pingueculae are mostly asymptomatic and may only be noticed when the eye becomes red from another cause (e.g. conjunctivitis). Please see diagnostic photograph.

Pterygium

This is a growth of the conjunctiva which grows, usually at 3 and 6 o’clock, on the cornea. There is often a history of UV exposure. Patients can be asymptomatic or they can cause discomfort and FB sensation. Occasionally pterygia can become inflamed. Please see diagnostic photographs.

Who to refer

Mostly pingueculae do not require surgical removal, and do not require onward referral. Very occasionally pingueculae can be recurrently inflamed and can be considered for surgical removal.

If the patient has a persistently symptomatic pterygium and the patient wishes to pursue surgery, please refer to the Corneal Outpatient Department. Also consider referral for patients with significant growth on to the cornea.

Be suspicious of neoplastic growths if the pingueculum or pterygium is not typical or changes in size/shape/pigmentation.

Red Flags

Pingueculum and pterygium can occasionally both become inflamed causing significant red eye, pain, photophobia. If this occurs, see the advice below and consider referral to the BEH Emergency Department

Before referral

Pingueculum

Very occasionally the pingueculum may become inflamed and cause mild discomfort and foreign body sensation. In these occasions a cool compress and tear substitutes may provide some relief. If symptoms persist, they may require a topical steroid being prescribed and the best way to enable this is through the BEH Emergency Department.

Mostly pingueculae do not require surgical removal, and do not require onward referral.

Pterygium

Treatment should be directed at avoiding further UV exposure, tear substitutes may help with foreign body sensation and discomfort. Very occasionally they can become inflamed and require topical steroids, if symptoms are significant please consider referral to the BEH Emergency Department.

Referral

If referral is required please submit to Ophthalmology via eRS requesting Cornea clinic.

Resources

These guidelines have been written by Rhys Harrison, consultant ophthalmologist at Bristol Eye Hospital, with thanks to the patients who have kindly given consent to use their photos.

For full ophthalmology guidelines see: Primary Care Ophthalmology Guidance Document

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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