Wing skin surgery (pterygium)

Pterygium is a growth of tissue in the conjunctiva that spreads to the cornea where it becomes visible as a triangular opacity. Over time, the pterygium can cause visual acuity to deteriorate. Chronic irritation of the conjunctiva due to a disturbance of the tear film, caused by the pterygium, is also a frequent reason for surgery. The only way to treat a pterygium is to remove it surgically. At our eye clinic, we perform pterygium surgery using modern procedures that allow us to significantly reduce the risk of recurrence.

What is pterygium?

Pterygium is a benign growth that originates in the conjunctiva and grows over the cornea. The pterygium usually develops in the inner corner of the eye and spreads from there in the shape of a triangle towards the centre of the cornea. This not only results in an aesthetic impairment, but can also considerably limit vision. The exact causes for the formation of wing fur are still unclear.

Apparently, there are several factors that can contribute to its development. The most important risk factor is UV light. People who are exposed to increased UV radiation in their work or leisure time are more prone to developing pterygoid. The most important measure to prevent a pterygium or its recurrence is accordingly consistent sun protection in the form of sunglasses. Pterygium can also occur due to injuries, diseases or after eye infections (especially herpes simplex).

For this reason, we always keep the possible causes in mind during treatment. If necessary, the underlying disease should also be treated in addition to the wing skin operation. 

How does a pterygium manifest itself?

A pterygium is usually visible to the naked eye as a growth on the cornea. Typical signs of a pterygium are redness, itching and a persistent foreign body sensation. When the pterygium spreads over the cornea, vision can be limited. This is caused by an increasing curvature of the cornea (astigmatism). It is caused by the pterygium pulling on the cornea. In very advanced cases, when the pterygium has already grown over the centre of the cornea and thus over the optical axis, this considerably limits the ability to see. Although the pterygium can also be removed from the centre of the cornea, a certain amount of scarring is often unavoidable. Accordingly, the prognosis for permanent vision is then limited. It is therefore advisable to surgically remove the pterygium before it reaches the optical axis.

Although the pterygium is benign, its appearance can resemble malignant tumours, which is why it is important to make an exact diagnosis. The tissue removed during the operation is examined in the laboratory for possible malignant changes. In this way, we can offer you the greatest possible certainty. 

How can a wing fur be treated?

The treatment of a wing fur is surgical. The wing fur is removed from the cornea and the resulting defect is covered with a conjunctival graft. The wing skin operation takes about 30 minutes. As a rule, the operation can take place under local anaesthetic with sedation. In this case, the patient receives sedative and painkilling medication from the anaesthetist via the arm vein before the eye is locally anaesthetised. 

A wing fur does not always have to be surgically removed. As long as the benign growth does not cause any discomfort, it is usually sufficient to monitor it closely. A pterygium operation should be performed if the wing fur grows, approaches the pupil or if a corneal curvature occurs. Constant redness of the eye due to a tear film disorder may also require pterygium surgery.

What forms of pterygium surgery are there?

In pterygium surgery, we distinguish between surgery with and without a conjunctival graft. In the past, the pterygium was usually only removed. The resulting tissue defect was covered by suturing or moving neighbouring parts of the conjunctiva. However, this surgical method often resulted in a recurrence (recurrence of the wing fur). In our eye clinic, we therefore prefer the complex technique of conjunctival transplantation.

In this procedure, the pterygium is first surgically removed and then a so-called free conjunctival graft is sewn or glued on to close the resulting defect. We usually obtain the graft from the same eye in the area covered by the upper eyelid. The patient suffers neither functional nor cosmetic impairment as a result. A wing skin operation with conjunctival graft is also suitable for treating larger wing skins and those that have recurred after an initial operation. The risk of recurrence is significantly reduced. In the case of recurrence, local medication can also be applied during surgery to minimise the risk of re-growth.

What is the procedure for pterygium surgery?

Before the pterygium operation, your attending ophthalmologist will have a detailed consultation with you. He or she will explain the possibilities of a pterygium operation to you and also inform you about possible risks and side effects. As a rule, an operation is considered if you have a visual impairment due to the wing fur, if a growth tendency is detected or if there is chronic irritation of the eye due to the wing fur. The decision for or against the operation is made by the doctor together with you. The operation is always preceded by a detailed ophthalmological examination. It may be necessary to temporarily discontinue certain medications (e.g. blood thinners). This should always be done in consultation with the prescribing doctor. You should come to your pterygium operation without make-up.

The pterygium operation usually takes place under local anaesthetic with sedation and only lasts a good half hour. In the first step, the surgeon removes the wing skin under the operating microscope with a scalpel and scissors. Any remaining wing skin is carefully ground off the cornea. Then the defect in the conjunctiva is closed with a graft that was previously obtained from the region under the upper eyelid.

The eye is now covered with a bandage, and depending on the findings, a therapeutic contact lens may also be used to relieve pain.

What should be considered after the pterygium operation?

After the pterygium operation you should allow yourself some time off for a few days. It is important not to rub the treated eye during the first weeks. Redness of the operated eye may persist for a few weeks after the operation. In the first 1 to 3 days after the operation, patients often feel a distinct foreign body sensation. We can alleviate this with ointments, cooling and painkillers. As a rule, light activities can be resumed after 5 to 7 days. You should refrain from sports and physical exertion for at least 1 week, or longer depending on the recommendation of the attending physician. For a complication-free healing, you should take the prescribed eye drops and medication as prescribed by your doctor.

Are there any risks associated with pterygium surgery?

As with any operation, complications such as secondary bleeding or infection can never be completely ruled out. Complete or partial loosening of the conjunctival graft in the first post-operative days is also rare. In this case, sutures have to be repositioned in the operating theatre.

The greatest risk is the recurrence of winged skin. However, modern surgical techniques allow us to reduce the likelihood of recurrence to a minimum.

Can the wing fur recur after the operation?

Occasionally, a recurrence (recurrence) at the same site is observed after wing skin surgery. In our eye clinic we therefore work with modern surgical procedures. We can considerably reduce the risk of a recurrence by means of conjunctival transplantation. Even if the initial operation was unsuccessful, we perform a pterygium operation with conjunctival transplantation if necessary.