Pterygium
The growth of a pterygium is most commonly due to excessive sun (UV light) exposure. They are therefore very common in Australia, and particularly in patients who have spent a lot of time outdoors for work or recreation. They may appear early in a patient’s life (in their early 20’s) and gradually increase in size over time. They are particularly common in patients who surf and are often called “surfer’s eye”!
Most patients will be able to see their pterygium on the surface of their eye when they look in the mirror.
Your pterygium may cause:
- Grittiness, foreign body sensation, irritation of the eye
- Redness over the pterygium (particularly after being in the sun or wind)
- Visual disturbance (blurred vision, distorted vision)
If it is a small pterygium that is not causing any symptoms, then conservative treatment is usually all that is required. Regular lubrication of the eye with good quality artificial tears will improve the irritation and redness seen with the pterygium.
Protection of the eyes from sunlight with dark wrap-around polarised sunglasses will also reduce irritation and redness, and prevent further growth of the pterygium.
However, when a pterygium become frequently red or irritated, causes visual problems, or becomes cosmetically unsightly, then surgery is recommended.
Pterygium surgery
Pterygium surgery involves careful removal of the pterygium, including both the base (in the conjunctiva), and the tip (that is growing on the clear window of the eye). A blade or burr is used to gently smooth the corneal surface as much as possible to reduce corneal scarring and visual disturbance.
A healthy conjunctival graft is then taken from the same eye, in the area under the upper eyelid. This is inserted into the area where the pterygium was, and sutured or glued into place. This graft improves the healing of the area and reduces the risk of the pterygium growing back. Any sutures used are self-dissolving and do not have to be removed later.
Pterygium surgery is usually performed under local anaesthetic with a mild sedative. The eye is numbed with anaesthetic eye drops as well as an injection placed into the lower eyelid (not the eye itself). The anaesthetic will take all pain and vision away, so that patients do not feel or see anything during their eye surgery. Having a local anaesthetic also means that patients can return home fully alert, without any of the grogginess or side effects of a deeper general anaesthetic.
Occasionally a general anaesthetic will be recommended. For example, patients who are extremely claustrophobic, anxious, or unable to lie flat and still for the duration of the operation, may require a general anaesthetic. They should still be able to return home the same day.
An eye pad is placed on the eye after surgery. Patients will be observed for 1-2 hours on the ward after surgery before being discharged home with their carer. Patients are not allowed to take a taxi or drive themselves home.
The eye pad is removed the following day to commence application of prescribed postoperative eye drops. These eye drops are supplied to patients when being discharged from hospital.
Patients will have an appointment to attend Peel Vision within the first few days after surgery to ensure that they are comfortable and not having any problems.
The final postoperative check-up is usually 4 weeks after surgery. At that visit Dr Then will ensure that the eye has fully recovered and that the patient is fully satisfied with their result.
Due to the sutures, the eye will usually be gritty and uncomfortable for 1-2 weeks, after which it will gradually improve. The eye may also water and vision may be mildly disturbed in this period also.
The graft in the corner of the eye will appear red and swollen, particularly in the first few weeks after surgery. It can take months for the area to look white and clear.
Patients can generally see well enough to drive within a few days and can generally return to work when comfortable, which is usually within the first week. This will however vary according to the degree of discomfort and visual disturbance that is experienced.
If you have a pterygium in both eyes that require surgery, it is recommended that they be removed one at a time rather than at the same time. Dr Then will generally recommend that pterygium surgery is performed 4 – 6 weeks apart to each eye.
Bilateral simultaneous surgery is possible though patients will have significant discomfort in both eyes for 1-2 weeks after surgery, and this may have an impact on driving and returning to work.
Pterygium surgery is generally a safe and low-risk procedure. However, it is not a risk-free procedure.
Common risks include:
- Infection
- Movement of the graft
- Change in prescription of glasses due to corneal shape change
- Recurrence of pterygium
Uncommon and rare risks include:
- Penetration of eye (during suturing of the graft)
- Double vision (from disturbance of an underlying eye muscle)
These risks are extremely rare and can be treated if they occur.
The use of a graft will greatly reduce long-term recurrence rates to <5%. However, patients are still encouraged to always reduce excessive sun exposure with the use of dark polarized sunglasses and a hat.
DO:
- Complete the full prescribed course of postoperative eye drops provided
- Keep the eye clean and safe
- Wear dark glasses when outdoors, and use additional eye drops for dry eye
- Drive when your vision feels clear
- Return to work when your vision feels clear
- Return to recreational activities when you feel comfortable to do so
- Resume any contact lens wear on the advice of Dr Then
DON’T:
- Drive within 24 hours of surgery
- Swim within the first 4 weeks after surgery
The cost of surgery is variable depending on whether or not you have private health insurance that covers for pterygium surgery.
1. If you have Private Health Insurance:
We recommend contacting your health fund to check if you are covered, before proceeding with any bookings.
You will be quoted for any out-of-pocket expense (gap) for your surgical fee, prior to making any booking for surgery. Dr Then is committed to capped gap agreements to minimise patient costs. Your health fund will advise you if you have any hospital excess to pay for your admission, and our anaesthetists kindly do not charge an out-of-pocket expense for pterygium surgery.
Using your private health insurance gives you the choice of hospital for surgery and allows you to book surgery at your convenience.
2. If you don’t have Private Health Insurance:
a) Public
Public surgery is available at Peel Health Campus for Medicare card holders. There is no cost involved with public surgery however there is a wait list. The length of time waiting for surgery is unpredictable and can vary with government restrictions. Some restrictions for surgery may apply depending on your locality.
b) Self-funded surgery
Self-funding surgery is an option for patients who do not have private health insurance, do not want to wait (or do not qualify) for public surgery. Cost is variable depending on Concession and Medicare eligibility.
Feel free to contact our team for further details.
