Pictorial case study

THE CASE 

A 60-year-old woman presented in the surgery because she was concerned about the appearance of her left eye. She had recently noticed the onset of a fleshy growth over the medial aspect of the eye. It was not painful but she was becoming concerned because she was able to see it in her visual field. She was otherwise well and had no history of any eye disease. She wore glasses for reading only.

On examination, there was an obvious fleshy triangular-shaped growth over the nasal aspect of the left eye. Examination of the eye was otherwise normal and her visual acuity was unaffected.

What is the diagnosis, management and differential diagnosis?

Diagnosis and management

The diagnosis is pterygium which is a degenerative condition associated with excessive UV exposure and so more common in those who live in the tropics. It manifests as a raised, winged triangular or wedge-shaped growth of conjunctiva extending from the conjunctiva into the peripheral cornea and almost always affecting the nasal aspect. Its aetiology is unknown.

In general a pterygium does not require treatment as it is harmless and normally asymptomatic. However, indications for excision include cosmesis, visual disturbance and recurrent inflammation. In this woman's case she underwent surgery because she felt that the pterygium was causing visual disturbance and she did suffer from recurrent inflammation over a few months. There may be recurrence after surgery.

Possible different diagnoses

- Pinguecula.

- Allergic conjunctivitis.

Differential diagnosis

Pinguecula

- Confined to the conjunctiva, unlike pterygium which invades the cornea.

- It affects both the nasal and temporal aspects of the eye.

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