What’s the difference between a pterygium and a pinguecula?’ a patient asked me the other day, when we had barely left winter behind. Spring has finally arrived after an unseasonably cold start.
We’re starting to get back out in the sun again after months huddled up in front of the TV or laptop.
Our bodies will thank us for some much needed Vitamin D from the sunlight on our skin, but what about our eyes? How do we protect them from getting pterygium and pinguecula this summer and what’s the difference between them?
What is a pinguecula?
A pinguecula is a raised yellowish lesion on the white of your eye, close to your cornea. It can be on either side (3 o’clock or 9 o’clock) but more commonly occurs on the side nearest your nose. It is a localised degeneration of your conjunctiva (the cling-film-like layer that covers the front of your eye and back of your eyelids). Exposure to UV radiation from the sun causes the conjunctiva to produces more elastin fibres, which can bunch up and cause the pinguecula. The name comes from the Latin word ‘pinguis’, which means fat, and a pinguecula does indeed look like a fatty deposit due to its colour and translucency.
Pinguecula is more common over the age of 40, but you can get it in your 20s or 30s, especially if you spend a lot of time outdoors in the sun. Australia is the perfect incubator for a pinguecula, with its sunny skies and the hole in its UV-protective ozone layer.
A pinguecula is benign, and generally requires no treatment. It may be a little uncomfortable at times, as it is difficult for your tear film to lubricate it properly, but this is usually easily managed with some artificial tears. Rarely, surgical treatment is indicated, but usually only if the pinguecula is rendering your contact lenses unwearable due to a poor fit in the raised area. If it becomes red and inflamed, anti-inflammatory drops will usually calm it down.
What is a pterygium?
A pterygium is a wedge-shaped fibrous growth of conjunctival tissue across the cornea, usually on the nasal side. UV light passing through the cornea is intensified in this area, leading to changes in the conjunctiva. It is caused by UV light exposure and sometimes referred to as surfer’s eye. It can also be associated with dry, dusty environments.
Symptoms can include redness, discomfort, irritation, and, if it grows across the cornea, blurred or distorted vision. Advanced cases where the pterygium is encroaching onto the cornea require surgical removal, especially if there is any distortion in vision or the growth is starting to cross the pupil. Surgery is very successful and involves the removal of the growth and the graft of a band of conjunctival tissue taken from behind your own upper eyelid. This hugely reduces the chances of regrowth.
How can I avoid a pinguecula or pterygium?
The best way to avoid either a pinguecula or pterygium is to protect your eyes from UV light. Especially if you live in a sunny climate, you should ensure a pair of good quality, close fitting sunglasses are worn when outdoors. We are more at risk of UV light exposure in winter, funnily enough, as the sun is lower and the UV light can enter our eyes more easily. We are also exposed to considerable UV light when we are in the shade, so keep your glasses on in the shade too!
Sunlight can get around sunglasses. If you spend above average time outdoors, make sure your sunglasses provide good protection from the sides. Wrap styles are good. A broad brimmed hat will also help reduce UV light from above. Radiation from the sun doesn’t just cause pterygium and pinguecula. UV radiation can also cause cataract and blue-violet light (visible light at the part of the spectrum next to UV light) can penetrate even deeper into the eye and in implicated in macular degeneration.
When it comes to sun-exposure, sunglasses are just as important as slip, slap, slop. Make them your trademark!