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Pinguecula and Dry Eye Disorder

Pinguecula is some kind of lesion on the eye – and so is pterygium. The two disorders resemble each other so much they are often mistaken for one another.

A pinguecula (plural, pingueculae) is a thick surface lesion along the sclera (the white area) of the eye near its borders with the cornea. The lesion is elevated slightly and white to yellow in colour. The pinguecula usually starts in the palpebral fissure (the surface area dividing the upper and lower eyelids). It appears more opaque than healthy conjunctiva (the mucous membrane coating the inner eyelid surface and the white of the eye), has a oily appearance, and is more likely to be located on the nose (rather than the ear) side of the eye.

Pterygium (plural, pterygia) is a triangular, wing-like lesion that actually invades the cornea, generally near the nose and in the area continuous with the conjunctiva. It can be detected by its head – a raised, creamy, opaque tissue on the cornea. Though frequently not sight-threatening, severe pterygium can inflict corneal blindness.

The two lesions are similar in cellular/tissue structures. A pinguecula is distinguishable from a pterygium by its position relative to the cornea and the horizontal orientation of its damaged tissues. However, a pinguecula can transform into a pterygium when it crosses over onto the cornea.

Causes

The causes of pinguecula and pterygium are not clearly established. There is sound evidence, however, that both conditions are strongly associated with repeated, long-term exposure to the blue and ultraviolet bands of the light spectrum. It is not coincidental that they are more likely located around the cusp of the cornea, which is the part with greatest exposure to sunlight. The cornea and conjunctiva suffer cellular damage from exposure to ultraviolet radiation, especially when reserves of the helpful antioxidants glutathione and astaxanthin are reduced.

Pinguecula is also associated with increasing age. Pingueculae have grown in most eyes by age 70 and in practically all eyes by age 80. This is most likely a consequence of gradual deterioration of the conjunctiva, as a result of aging, past inflammations, chronic irritation, and dryness of the eyes.

Pterygium has been inextricably associated with patients living at latitudes of 37 degrees north and south of the equator – which appears to bolster the association with UV-light exposure. Hereditary influences have also been described. Another cause is human papilloma virus infection.

In the same way as pinguecula, pterygium is suspected to develop from constant presence to dust, low humidity (which can induce rapid tear evaporation and dry eyes), and tiny damage from particles in the air such as smoke and sand. Dry eye symptoms may also be confounding factors.

Though pterygium is often viewed as a deep-rooted degenerative disease, some of its indicative characteristics point to a abnormal growth disorder – not unlike some benign tumours. After surgery, pterygia have exhibited a potent and invasive propensity to recur.

Symptoms

Pingueculae normally do not cause trouble. You may get a foreign body feeling from an inflamed pinguecula. Severely dry conditions and other environmental factors can induce inflammation and enlargement.

You generally will not experience any symptoms from pterygium. But enlarged and irritated pterygia may cause foreign body sensation and some cosmetic apprehensions about the appearance of your eyes. Swollen or more well-developed pterygia, however, can lead to astigmatism as the growth exerts pressure on your cornea.

Treatment

Swelling in the pinguecula (known as pingueculitis) is very receptive to treatment with non-steroidal anti-inflammatory drugs or, if necessary, topical corticosteroids. The accompanying dry eye symptoms can be treated with eye drops. If you intend to go outdoors, it will be prudent if you to protect your eyes from sunlight with a good set of sunglasses. Surgical removal of a pinguecula is seldom necessary.

A small but swollen pterygium may be addressed by corticosteroid drops to suppress the inflammation. Dryness in the eye may be pacified with prescription eye drops.

Large pterygia may be better neutralised by surgical excision. The excision procedure is easy, but preventing re-emergence is not simple. Due to its aggressive tendency to regenerate, your doctor’s treatment strategy may resemble anticancer strategies, such as wide surgical removal to uproot all possible pterygium-affected tissues, beta-radiation radiotherapy, and chemotherapy with mitomycin C, an anticancer compound.


Source by Owen B Nelson

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