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Pterygium research and treatment have seen substantial advancements over the past few decades, with significant contributions from dedicated researchers and clinicians around the world. A pivotal figure in this progress is Professor Lawrence Hirst, who has been at the forefront of developing innovative treatments for pterygium. His work has contributed immensely to the peer-reviewed scientific literature on pterygium, more than any other individual in Australia or abroad.
One of Professor Hirst’s most notable achievements is the pioneering of the P.E.R.F.E.C.T. for PTERYGIUM® technique, a method that has revolutionized the treatment of pterygium over the last 25 years. This technique stands as a testament to the evolution of pterygium surgery, having been refined through careful adjustments to existing surgical approaches. It has been employed in over 4,000 patients, demonstrating exceptional success rates that are among the best reported in the world’s scientific literature. The technique is distinguished not only by its effectiveness in preventing recurrence but also by its superior cosmetic outcomes, often making it impossible to discern which eye was treated a year post-surgery.
The development and dissemination of the P.E.R.F.E.C.T. for PTERYGIUM® technique underscore the broader history of advancements in the field, highlighting how research and innovation have paved the way for improved patient care. This method is highly recommended for individuals seeking both functional and aesthetic solutions to pterygium, reflecting a significant step forward in the field.
To further the reach of this groundbreaking surgical method, the PARTNERS in P.E.R.F.E.C.T. for PTERYGIUM® initiative was established. This program facilitates the training of accredited practitioners in different regions, ensuring that more patients can benefit from this advanced treatment. Dr Tanya Trinh is the only Sydney based surgeon offering this technique.
Other notable surgeons who have mastered this technique under Professor Hirst’s guidance include Dr. Katherine Smallcombe, Dr. Todd Goodwin in Townsville, Dr. Juanita Pappalardo in Brisbane, and Dr. Brett Drury on the Gold Coast. Collectively, their expertise has expanded the availability of this exceptional surgical approach across Queensland and beyond.
Pterygium, (plural “pterygia”), represents an extremely common condition affecting the eye, characterized by an abnormal growth emerging from the conjunctiva (a clear vascular coating overlying the white part (sclera) of the eye) and extends over the cornea, the eye’s clear, crystal window. The cornea, a 12mm wide aperture, plays a crucial role in vision as its transparency dictates clarity of vision. Therefore, any growth of tissue obstructing or distorting this clarity becomes problematic.
Described as a “wing of tissue,” a pterygium typically originates from the side of the eye closest to the nose (nasal side). However, in rare instances—less than 1% of cases—it may develop from the side nearest to the ear (temporal). Pterygia are most frequently diagnosed in adults over the age of 20 or 30, though they have can be observed in teenagers.
It is important to note that a pterygium is not cancerous per se, but rather a localized abnormality on the eye’s surface. After an initial period of growth (during which the pterygium may extend 1, 2, 3 millimeters, or more across the cornea), its progression typically stabilizes but where and when it stops is very variable. In rare cases, the growth may advance to the point where it interferes with the line of vision.
Although it is less common, some individuals may experience the development of a pterygium in each eye. Even more rarely, a person may have two pterygia on each eye, underscoring the varied presentation and impact of this condition.
Symptoms: A pterygium may first appear as a small growth on the white part of your eye, which might be whitish or reddish. While often symptomless, you may experience a sensation of mild irritation, such as itchiness or a scratchy feeling. In certain environments—like windy, sandy, or smoky areas, or when exposed to bright sunlight or air conditioning for extended periods—the pterygium can become inflamed, leading to more noticeable redness and discomfort. If the growth extends significantly onto the cornea, it might induce vision problems like blurring or induce astigmatism by altering the shape of the cornea.
Prevalence: Pterygia are a relatively common condition, particularly in areas with high sun exposure. Research from our group indicates a prevalence rate of up to 10% in Queensland’s population, with slightly lower rates in the southern states of Australia.
Causes: Sunlight exposure plays the most significant role in the development of pterygia. Our studies have found that individuals who spend their childhood years in sunny climates, like Queensland, have a 40 times higher risk of developing a pterygium compared to those who grow up in less sunny settings, such as Victoria. The risk correlates strongly with the amount of UV exposure during the first ten years of life and continues to be a factor with ongoing exposure.
Diagnosis: Recognizing a pterygium is typically clear-cut, but confirming the diagnosis should be done by an eye care professional, as it can sometimes be mistaken for other eye surface conditions like pinguecula or even ocular surface cancer. A definitive diagnosis usually involves examining the eye with a slit lamp, a type of microscope that provides a detailed view of the eye’s surface. Occasionally your eye surgeon may recommend removal or a biopsy to ascertain the true identity of the lesion under a microscope.
Prevention: The best prevention for pterygium is protecting the eyes from UV radiation. Children, in particular, should be shielded from intense midday sun with broad-brimmed hats, stroller awnings, and high-quality sunglasses that comply with Australian standards. Wearing proper UV protecting sunglasses can significantly reduce the occurrence of pterygia.
Navigating the journey of pterygium treatment necessitates a nuanced understanding and an approach tailored to each individual’s condition. As an ophthalmologist with a specialized focus in cornea, cataract, refractive, and pterygium surgery, my practice is grounded in delivering care that not only addresses the condition but also aligns with each patient’s lifestyle and vision goals.
Observation is an option for some: For many individuals with pterygium, active intervention may not be immediately necessary. I certainly do not recommend surgery for every pterygium that I see. The key is these cases is vigilant monitoring—something patients can often undertake independently or with the help of their optometrist. Regular self-examinations can be quite effective, though some aspects of the pterygium, particularly those near the pupil, may require professional evaluation to accurately assess any changes. I recommend a comprehensive eye examination periodically, ensuring any growth remains under careful observation.
Managing Irritation: Experiencing redness or discomfort from a pterygium can be particularly distressing. For temporary relief, certain over-the-counter medications such as preservative free lubricants may offer respite, especially during times when environmental factors exacerbate symptoms. Rarely, some inflammation may require the short term use of very low dose steroids to manage – however, it is crucial to approach these remedies with caution, as their prolonged use can lead to dependency and potential adverse effects, underscoring the importance of moderation and medical guidance.
Surgical Considerations: When the presence of a pterygium challenges one’s visual performance and/or aesthetic preference, surgical intervention becomes a consideration. My philosophy embraces a comprehensive evaluation to determine the necessity of surgery, extending beyond traditional criteria to include the patient’s personal concerns and the functional impact of the pterygium.
The choice of surgical technique is paramount. While no method guarantees complete recurrence prevention, the autoconjunctival transplant procedure—where the pterygium is removed and the area is repaired with the patient’s own tissue—has consistently shown promising outcomes in terms of safety and efficacy. This approach minimizes the risk of recurrence and avoids the complications associated with alternative treatments, such as the use of adjunctive medications or radiation therapy.
A Commitment to Excellence: The decision to undergo surgery for pterygium removal is made with a deep understanding of the patient’s individual needs and the latest advancements in treatment. My commitment is to provide an informed, compassionate pathway to care, leveraging my expertise to achieve outcomes that enhance not only vision but also the quality of life.
As your partner in eye health, I am dedicated to guiding you through the complexities of pterygium management, ensuring you receive the highest standard of care informed by the latest research and my extensive clinical experience. Together, we will explore the most appropriate strategies to address your pterygium, prioritizing your comfort, vision, and overall well-being.
The eye’s appearance will appear much more normal after surgery. In our published studies, both patients and surgeons were often unable to identify the eye that had undergone surgery. It generally takes about 6 months to settle down to this appearance. Naturally, the larger and more extensive the pterygium is, or the more severe the recurrence (if you have had surgery elsewhere initially), the appearance of the eye will still look much more normal but the expectations may need to be more realistic, owing to the severity of the condition in the first place. Large pterygia extending over the cornea will always leave some footprint behind as it is not safe to scrape all of this scar tissue off. This is why not allowing a pterygium to grow so large is to your benefit.
While a pterygium is unlikely to cause complete blindness, significant growth without treatment can impact vision by direct obstruction of vision or distortion of vision.
No, it is not cancer. However, about 10% may show pre-cancerous changes, highlighting the importance of pathology analysis post-removal. We will always send the tissue off to the pathologists for all of our surgeries and will contact you if there are concerning reports received back from the laboratory.
No, they are completely different. A cataract affects the lens inside the eye and is more related to aging, whereas a pterygium is a surface condition and is more related to UV exposure.
We will recommend removal if the lesion is felt to interfere with your vision. The overwhelming majority of cases (where it is removed for this indication) experience visual improvement. Please note this does not mean spectacle or contact lens independence. You may still require glasses correction due to other reasons inherent in your eye ie cataracts, pre-existing glasses prescription, corneal distortion. In some cases, patients may need an update of glasses after the surgery. Any large pterygium removal will always leave a footprint behind – if the pterygium already extends over the centre of the vision (the pupil) the best we can do is improve this for you, but expecting perfection is not reasonable.
Direct inheritance is unlikely. Similar sunlight exposure among family members is likely to be a more common link.
Due to the extensive nature of the technique, we will space removals 6-12 months apart for optimal results to allow healing and effective graft size for each pterygia.
Yes, a referral from your GP or optometrist is needed for Medicare rebates. You are also able to self-fund if you wish (no rebate available); a quote is available by contacting the rooms – this is generally the option taken by our international patients.
Typically, follow-ups are scheduled for one day, one month, and three or four months and then 12 months post-surgery. Some of the latter appointments may be performed in conjunction with your local treating team at your own cost if travel distance is an issue (ie international patients).
The first year is crucial for detecting any recurrence early. Our studies demonstrated that 97% of all recurrences would usually occur within the first 12 months of surgery. Having said that, recurrences using our technique is exceedingly low.
The day 1 must be performed by our team. The one month and 3-4 month appointment may be performed locally. The12 month appointment should be done with our team.
About one hour for first-time removals, and 1-2 hours for previously treated pterygia.
There is no seasonal restriction for surgery.
The P.E.R.F.E.C.T. method requires deeper surgery, making injections necessary for pain-free treatment. This makes for a significantly more pleasant experience for you.
With P.E.R.F.E.C.T. surgery, recurrence is about 0.1% for first-time treatments, and 1% for previously treated pterygia, marking our technique with the lowest rates in literature.
While sunglasses wear post-surgery does not directly influence recurrence rates, they are recommended to reduce future sun damage to both eyes (cataract formation, macular degeneration, eyelid cancers).
A small risk exists, managed with antibiotic drops and protective measures like wearing a sterile patch in risky environments for the first two weeks.
Swimming is off-limits for about a month, with potential temporary limitations on driving and working due to double vision and discomfort.
Yes, 1-2 weeks off is typical, with a medical certificate provided for 2 weeks for all patients.
Pain, managed with prescribed oral medication, typically lasts 1-3 days. A peribulbar block used during surgery helps control initial discomfort.
Temporary double vision is due to swelling around the muscle area, expected to resolve within a week or two.
Typically, redness fades within 4 weeks, though some blood or bruising might linger for 6-8 weeks.
Irritation commonly subsides within 2-4 weeks post-surgery when the stitches dissolve.
Eyelid swelling usually diminishes within 2-3 weeks.
Stitches are self-dissolving over 2–4 weeks and do not require manual removal. They soften after the first week, becoming less noticeable.
A patch keeps the eye clean and lowers infection risk while the eye’s surface heals, typically necessary for the first 1-2 weeks. You do not need to wear the patch during day time unless you are in a dirty environment ie local construction nearby.
Yes, in most cases the surgery may alter the cornea’s shape, moving it closer to its original form, necessitating new glasses to match the updated curvature. It is therefore possible that if you weren’t using glasses before, you might need them after the surgery.
There are two main eye drops used after surgery – antibiotics and steroid eye drops. Antibiotic drops prevent infection, while steroid drops for six weeks help reduce recurrence risk and aid recovery. This is a very, very important part of your treatment.
A small chance exists that the drops could increase eye pressure, monitored and managed during follow-up visits. This is why the one month check-up is absolutely crucial whether it is performed by our team or your local treated team.
Costs vary by individual cases and insurance coverage as no two private health insurers cover the same procedures for the same amounts. A detailed quote is provided after the initial consultation tailored to you.
Pterygium specimens are sent to the laboratory to check for cancerous changes. In our published studies, up to 10% of all specimens were identified to have precancerous changes, which, in Australia’s UV dominant climate, is crucially important. The amount charged goes to the laboratory for this service.
Dr. Trinh is a fully certified RANZCO (Australian) ophthalmologist with extensive fellowship expertise specializing in cornea, cataract and refractive surgery. She is also a fellow of the World College of Refractive Surgery and Vision Sciences.