Pterygium Surgery Melbourne — What to Expect

A pterygium is a wedge-shaped growth of fleshy conjunctival tissue that extends from the white of the eye onto the cornea. It is one of the more common reasons patients are referred to a corneal surgeon in Australia, where high UV exposure throughout life — particularly in childhood and early adulthood — is the dominant risk factor. Most pterygia grow slowly and remain stable for years. When they do require treatment, surgery is straightforward and recovery is predictable.

What causes a pterygium?

The single most important risk factor for pterygium formation is cumulative ultraviolet light exposure. The condition is significantly more prevalent in Australia than in countries at higher latitudes, and more common in people who have spent substantial time outdoors — farmers, outdoor workers, sailors, and keen cricketers or golfers are disproportionately represented among patients presenting with symptomatic pterygia.

A pterygium almost always grows from the nasal side of the conjunctiva — the side closest to the nose — and extends towards the centre of the cornea. Less commonly, a pterygium can grow from the temporal side (towards the ear). It is possible to have pterygia in both eyes simultaneously.

Dry eye disease and chronic ocular surface inflammation appear to be contributing factors. Pterygia are not cancerous and do not represent a malignant process, though they should be distinguished from other conjunctival lesions that can look superficially similar.

When does a pterygium need surgery?

Not every pterygium requires removal. Many patients are monitored with topical lubricating drops and UV protection and do not proceed to surgery. The indications for surgical removal include:

• Encroachment onto the visual axis, causing blurred vision
• Induced astigmatism causing a change in spectacle prescription that cannot be corrected satisfactorily
• Persistent redness, irritation, or foreign body sensation affecting comfort or appearance
• Documented progressive growth on serial slit-lamp photographs
• Restriction of eye movement in large pterygia (rare)

Removing a pterygium before it reaches the central cornea generally gives a better visual outcome and reduces the risk of leaving a corneal opacity that persists after surgery.

The surgical technique — conjunctival autograft

The current standard for pterygium surgery is excision combined with conjunctival autograft. This technique has replaced the older bare-sclera excision approach, which left the sclera uncovered after pterygium removal and was associated with recurrence rates as high as 30 to 80 percent.

The procedure involves two steps. First, the pterygium is carefully dissected off the corneal surface and sclera. The cornea is polished to remove residual tissue. Second, a small patch of healthy conjunctiva — taken from under the upper eyelid where it is not visible — is transferred to cover the bare area on the sclera left after pterygium removal. This autograft is secured with either fibrin glue (the most common approach) or fine absorbable sutures. The tissue-matched graft provides a healthy ocular surface, suppresses the regrowth stimulus, and dramatically reduces recurrence risk.

Surgery is performed as a day procedure under topical anaesthesia (eye drops) or light sedation with a local anaesthetic block. The procedure takes approximately 30 to 45 minutes and patients go home the same day.

Recovery and what to expect

The eye is padded or shielded for the first few hours after surgery. Most patients experience grittiness and light sensitivity for the first one to two weeks, managed with lubricating drops, steroid drops, and oral analgesics if needed. The eye is typically quite red for four to eight weeks as the graft heals into its new position — this is normal and expected.

Most patients can return to light desk work within a week. Driving is generally safe once comfortable and visual acuity has returned to baseline, usually within one to two weeks. Swimming, contact sport, and dusty outdoor environments should be avoided for four to six weeks.

Steroid and antibiotic eye drops are used for four to six weeks post-operatively. Regular lubricating drops support ocular surface healing and comfort throughout recovery.

Preventing recurrence

With the conjunctival autograft technique, recurrence rates are approximately one to five percent — a marked improvement over older methods. The most important modifiable risk factor for recurrence is continued UV exposure. Wearing wraparound sunglasses with UV400 protection and a broad-brimmed hat whenever outdoors is strongly recommended, not only to prevent recurrence but to protect the rest of the ocular surface.

Referrals for pterygium surgery are accepted at Northern Eye Consultants, Suite 5, Northpark Private Hospital, 135 Plenty Road, Bundoora, and at Bass Coast Eye Centre, Wonthaggi. For appointments or referrals, call (03) 9466 8822 or use HealthLink EDI nthneyec.