Protecting Eyes from the Elements: Understanding Pterygium (Surfer's Eye)

A pterygium is a fleshy overgrowth of the conjunctiva, or surface of the eye. This condition, also called “surfers eye”, often comes from spending excessive time outdoors in the sun.

While the name “surfer’s eye” can make the condition seem benign, a pterygium can obstruct vision and have more serious consequences if left untreated. It’s important for patients to learn a few key things so they can recognize if they might have surfer’s eye, get the appropriate treatment, and protect their vision.

Surfer's eye (or pterygium) is a growth of raised fleshy tissue on the conjunctiva. The conjunctiva is a thin, clear membrane which covers the inner surface of the eyelid and the white part of a patient’s eyes.

Pterygium are often triangular in shape. They typically begin on the inner corner of the eye closest to the nose, although they can form on either corner of the eyes. While the growths start small, they can spread outward and reach the cornea. When pterygium spreads like this it can affect a patient’s vision.

Surfer’s eye can be caused by long-term exposure to ultraviolet light from the sun and dry weather irritants like wind and dust. Generally the longer exposure the more likely it is a patient will develop “surfer's eye”.

Patients are more likely to get surfer's eye in certain climates. Researchers have described locations 37 degrees north and south of the equator as being part of the pterygium belt. These locations have higher rates of surfer’s eye. This “belt” runs through Richmond, VA to San Francisco and also includes locations such as Africa, Central America, and the Philippines.

Surfer's eye shares some things in common with another condition called Pinguecula. Both pterygium and pinguecula are both growths on the conjunctiva of the eye. Pinguecula is a yellowish, raised growth on the conjunctiva. Like a pterygium, it usually begins on the side of the eye closest to the nose.

However, there are a few key differences between the two growths. A pinguecula is made up of deposits of protein, fat, or calcium - and is limited to the conjunctiva. Symptoms for pinguecula are less severe and typically go away on their own, while a pterygium can extend to the cornea and affect a patient's vision.

There are a variety of symptoms for surfer’s eye. Some of the most common include:

• A raised pink growth on the eye, often starting near the patient’s nose

• Irritated or swollen eyes

• Feeling a dry, itchy, or burning sensation in or around the eyes

• Sensation of particles of sand or grit in the eye

• Excessive watering or tearing.

Symptoms typically become more severe if the growth extends to the cornea. In scenarios like this patients may experience blurred or double vision.

While surfer’s eye is not a form of cancer, there are risks to a patient if the condition goes untreated. Risks compound if the pterygium spreads to the cornea of the eye. If the growth covers the cornea, patients may experience vision loss.

The best course of action should a patient notice an unusual growth on their eye is to immediately schedule an eye exam with their doctor

The diagnosis of surfer’s eye will begin with a comprehensive eye exam. During the exam, the doctor will often use a slit lamp to diagnose the pterygium. This instrument is a type of microscope that shines a bright narrow light into a patient's eye, allowing the doctor to get a better view to make their diagnosis.

An eye doctor may also perform a visual acuity test to measure overall vision and see if any growth on a patient's eye has affected their ability to see. Additionally, patients may receive a corneal topography which creates a 3D map of the surface of the cornea.

If the doctor notices a growth, they may take pictures to monitor it over time and schedule additional tests.

Mild cases of surfer’s eye may go away on their own and not require treatment. Patients will typically receive treatment if the pterygium has spread or is disrupting their vision.

For treatment the eye doctor may recommend over-the-counter eye drops or ointments to lubricate the eye. If the patient is feeling discomfort in their eye, the doctor may prescribe a steroid eye drops or eye ointments to reduce pain, redness, itching and swelling.

In extreme cases a patient may need surgery. This will only be recommended if prescription eye drops and ointments aren’t alleviating pain or if the pterygium is blocking vision and causing the patient to have difficulty seeing.

Prior to surgery patients will consult with an ophthalmologist who will be able to determine size, atypical characteristics, and growth pace. In our office we recommend one of two procedures:

Conjunctival Autograft: As pterygium growth tends to recur, Conjunctival Autograft surgery is the most recommended treatment for it. The surgery not only removes the pterygium, but also reduces its chances of coming back. Furthermore, this procedure offers the best appearance results once completed.

Amniotic Membrane Graft: Another surgical option an eye doctor may employ, where a piece of amniotic membrane is sutured to the eye once the pterygium is removed

In extreme cases a patient may need surgery. This will only be recommended if prescription eye drops and ointments aren’t alleviating pain or if the pterygium is blocking vision and causing the patient to have difficulty seeing.

Prior to surgery patients will consult with an ophthalmologist who will be able to determine size, atypical characteristics, and growth pace. In our office we recommend one of two procedures:

Conjunctival Autograft: As pterygium growth tends to recur, Conjunctival Autograft surgery is the most recommended treatment for it. The surgery not only removes the pterygium, but also reduces its chances of coming back. Furthermore, this procedure offers the best appearance results once completed.

Amniotic Membrane Graft: Another surgical option an eye doctor may employ, where a piece of amniotic membrane is sutured to the eye once the pterygium is removed.

Since surfer’s eye is caused by UV radiation from the sun, the best way for patients to avoid the condition is by shielding their eyes from harmful UV rays. Some ways that patients can do this:

• Wearing sunglasses that protect against UV light damage. This will typically be glasses that provide 99 to 100% UV or UV400 protection and block both UV-A and UV-B rays.

• Using a broad-brimmed hat that shields the eyes from the sun.

• Avoiding the sun at the most intense times of the day. This is typically later in the morning and early in the afternoon, between 10am and 4pm.