The second group presents with a history of rapid growth and a significant elevated fibrovascular component. The pterygia in this group have a more aggressive clinical course and a higher rate of recurrence following excision. A genetic predisposition to the development of pterygia appears to exist in certain families. A predilection exists for males to develop this condition in significantly higher numbers than females, although this finding may represent an increased exposure to ultraviolet light in this portion of the population. Corneal topography can be very useful in determining the degree of irregular astigmatism induced by advanced pterygia.
External photography can assist the ophthalmologist in following the progression of the pterygium.
Multiple different procedures have been advocated in the treatment of pterygia. Recently, the use of free grafts of conjunctiva and limbal tissue at the same time as primary excision of the lesion have been advocated widely as the preferred treatment modality for most, but especially aggressive, pterygia. Pterygia can be removed for cosmetic reasons, as well as for functional abnormalities of vision or discomfort. Surgery for excision of pterygia usually is performed in an outpatient setting under local or topical anesthesia with sedation, if necessary. In addition, the use of ultraviolet-blocking sunglasses is advisable to reduce the exposure to further ultraviolet radiation.