Updated: 12/15/2018

Pterygium

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Topic
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Questions
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Evidence
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Topic
https://upload.medbullets.com/topic/120495/images/pterygium.jpg
Snapshot
  • A 66-year-old man presents to his primary care physician for evaluation of an abnormal growth of the eye. He reports that his wife noticed this growth. He denies any pain, discomfort, or impairment in his visual field in the affected eye. He denies having any chemical exposure to his eyes. Medical history is unremarkable. He works as a farmer and reports spending most of his day out in the field. On physical exam, there is a wedge-shaped growth extending onto the cornea.
Introduction
  • Definition
    • a collection of fibrovascular conjunctival tissue 
  • Epidemiology
    • incidence
      • most common in tropical regions
    • risk factors
      • chronic sun exposure (especially ultraviolet light)
  • Pathogenesis
    • likely multifactorial, involving neovascularization and extracellular matrix remodeling
  • Prognosis
    • may lead to visual impairment and reduced ocular motility if not treated
    • can lead to cosmetic concerns
    • there is a > 90% recurrence within the first 12 months after the pterygium is excised 
Presentation
  • Symptoms
    • patient concerned for cosmetic reasons
    • may have mild visual impairment
  • Physical exam
    • redness and irritation
    • wedge-shaped growth extending onto the cornea  
Studies
  • Making the diagnosis
    • this is a clinical diagnosis based on history and physical exam
Differential
  • Pinguecula
    • differentiating factors
      • round, yellowish, and elevated growth
Treatment
  • Operative
    • surgical excision
      • indication
        • definitive therapy used when the pterygium involves the visual axis or has an appearance concerning for dysplasia
Complications
  • Recurrence post-excision
  • Post-surgical complications (e.g., bleeding and infection)

 

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Questions (1)

(M2.OP.13.1) A 65-year-old man is brought to his primary care provider by his concerned wife. She reports he has had this "thing" on his eye for years and refuses to seek care. He denies any pain or discharge from the affected eye. A picture of his eye is shown below. Given the diagnosis, what are you most likely to discover when taking this patient's history?

QID: 106214
FIGURES:
1

He experienced shingles three years ago, with a positive Hutchinson's sign

9%

(8/89)

2

He suffered from recurrent conjunctivitis in his youth

20%

(18/89)

3

He grew up in Ecuador, where he worked outdoors as a farmer for 30 years

49%

(44/89)

4

He was involved in a bar fight and experienced a ruptured globe 10 years ago

6%

(5/89)

5

He suffered a burn to his eye while cleaning his bathroom with bleach 5 years earlier

15%

(13/89)

M 6 E

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Evidence (1)
EXPERT COMMENTS (2)
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