Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Pterygium

A pterygium is a fleshy, wing-shaped growth of conjunctiva across the limbus onto the cornea, linked to ultraviolet light exposure [S1] [S12]. It can impair vision, limit eye movements and cause irritation and dryness, and in some patients it grows across the visual axis [S1]. Surgery is the only effective treatment, and the main problem is recurrence [S1].

Key points - Ultraviolet exposure is the main risk factor [S12]. - Bare sclera excision alone has been reported to recur in upwards of 80% of cases; excision with a tissue graft lowers recurrence [S1]. - Conjunctival autograft recurs less than amniotic membrane at 6 months (RR 0.53) [S1]. - Fibrin glue may reduce recurrence and operating time compared with sutures (low-certainty evidence) [S2] [S11]. - Mitomycin C is the most effective adjuvant in a network meta-analysis; adjuvants carry toxicity risks [S3] [S8].

Evidence last checked: 2026-10-17 (PubMed abstracts).

Red flags

• Pterygium approaching or covering the visual axis, which can block vision [S1].
• Growing pterygium causing astigmatism. Pterygia of 3 to 4 mm pose a notable risk of residual aberrations, and earlier removal reduces this risk [S9].
• Scleral thinning, corneal toxicity or graft problems after antimetabolite use. 5-FU can cause scleral thinning and corneal toxicity, ranging up to severe and sight-threatening [S8].
• Restricted eye movement [S1] [S2].
• An atypical ocular surface lesion is not covered by these sources; refer if in doubt (see "Refer when").

Recognise it

• Appearance. A wing-shaped conjunctival growth crossing the limbus onto the cornea [S1].
• Symptoms. Irritation, foreign body sensation, dryness, reduced vision and restricted motility [S1] [S2].
• Risk. Ultraviolet light is a major contributor [S1] [S12]; prevalence ranges widely around the world [S1].
• Refraction. Pterygium causes refractive errors through localised corneal flattening near its leading edge [S9].

Confirm it

• Diagnosis is clinical; these abstracts do not describe grading systems.
• Measure refraction and, where available, keratometry: surgery improved astigmatism, keratometry and aberrations in most of 23 studies (1663 eyes) [S9].

Manage it

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

• Advise protection from ultraviolet exposure, the main risk factor [S12]. Specific protective measures are not covered by these abstracts.
• Refer when the pterygium threatens the visual axis, affects vision or is growing (see "Refer when") [S1] [S9].

Tier B (general eye clinic)

• Avoid bare sclera excision alone because of high recurrence [S1].
• Conjunctival autograft is preferred [S12]. In a Cochrane review of 20 RCTs (1947 eyes), conjunctival autograft had lower 6-month recurrence than amniotic membrane (RR 0.53, 95% CI 0.33 to 0.85), particularly for recurrent pterygia (RR 0.45) [S1].
• Graft site. Inferior and superior conjunctival autografts had similar recurrence in 4 RCTs (438 eyes) [S6].
• Graft fixation.
• Fibrin glue versus sutures (Cochrane, 14 RCTs): less recurrence (RR 0.47; about 5 fewer recurrences per 100 operations) and about 17 minutes shorter surgery, but possibly more complications (RR 1.92), all low certainty [S2]. A 2026 meta-analysis of 20 RCTs also found lower recurrence, shorter surgery and less day-1 pain with glue [S11].
• Autologous blood (where glue is unavailable): recurrence did not differ from glue or sutures, but graft retraction and displacement were more common; evidence was low quality [S4].

Tier C (specialist centre)

• Adjuvants. In a network meta-analysis of 34 RCTs (2483 patients), recurrence was reduced by mitomycin C (OR 0.12), beta-radiotherapy (OR 0.17) and bevacizumab (OR 0.38), but not 5-FU (OR 0.41, 95% CI 0.12 to 1.39) [S3]. Mitomycin C 0.02% for 5 minutes, with or without autograft, gave favourable 15-year outcomes in 40 eyes with recurrent pterygium, as reported in [S5].
• Bevacizumab. A meta-analysis of 17 RCTs found lower recurrence (RR 0.652) without more complications [S7].
• Topical cyclosporine 0.05% reduced recurrence after bare sclera and conjunctival flap rotation, but not significantly after autograft techniques, in 12 studies [S10].
• 5-FU. As a surgical adjuvant its efficacy is suboptimal and the reviewers do not recommend it; intralesional injection for impending or true recurrence was more promising, and its low cost suits resource-limited settings, but it needs caution and long-term monitoring [S8].
• Adjuvant dosing beyond what is quoted above is not covered by these abstracts: follow local protocols.

Refer when

Pitfalls

• Bare sclera excision alone [S1].
• Using 5-FU as an intraoperative adjuvant expecting reliable effect [S8].
• Late surgery for large pterygia, risking residual aberrations [S9].
• Ignoring graft complications with glue or autologous blood [S2] [S4].

Evidence notes

• Many autograft trials had unclear risk of bias, and too few used mitomycin C to judge its added effect [S1].
• Fibrin glue evidence is low certainty, with a possible excess of complications [S2]; graft retraction results were inconsistent [S11].
• Many trials come from Asia, the Middle East and Latin America [S1] [S2].
• Not covered by these sources: ocular surface squamous neoplasia, cost, and specific sun protection advice.

Related articles

• Ocular surface squamous neoplasia
• Dry eye disease

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.