Understanding Pterygium (“Surfer’s Eye”) – A Guide from an Eye Specialist in Mbombela

What is a pterygium?

A pterygium is a:

• Red, fleshy, triangular-shaped growth on the white part of the eye (conjunctiva)
• Most commonly found on the nasal (inner) side of the eye
• Benign (non-cancerous), but can still cause significant symptoms and cosmetic concern

In earlier stages, when the growth has not yet reached the cornea, it’s called a pinguecula. Once it starts creeping onto the clear cornea, we call it a pterygium.

As an eye doctor in Mbombela, I see pterygia frequently in people who spend a lot of time outdoors.

What causes pterygium?

The exact cause isn’t fully understood, but several factors clearly increase risk:

• Ultraviolet (UV) light exposure – strong sun, especially without eye protection
• Harsh environments – dust, wind, pollen, dry air
• Outdoor work or hobbies – farming, construction, fishing, water sports

Because of the strong sun and reflective surfaces, pterygium is sometimes called “surfer’s eye”. For example:

• Surfers are exposed to direct UV plus reflected UV from the water

• They often can’t wear sunglasses while surfing
• This combination puts them at especially high risk

Living in sunny Mpumalanga, many of my patients in Nelspruit and Mbombela have similar environmental exposure, even if they’re not surfers.

Symptoms of pterygium

In the early stages, a pterygium is often more of a cosmetic issue, plus mild irritation. Typical symptoms include:

• Redness, especially on the inner (nasal) side of the eye
• Foreign body sensation – feeling like something is in the eye
• Irritation or scratchiness
• Tearing or watery eyes
• Feeling of fullness or discomfort, especially in wind or sun

Symptoms may flare up and settle again. Triggers can include:

• Sun exposure
• Windy or dusty conditions
• Not sleeping well or fatigue
• Occasionally alcohol or general irritation

Can pterygium affect your vision?

Yes, as it grows.

A small pterygium usually:

• Does not affect vision
• Causes mainly irritation and cosmetic concern

As it grows onto the cornea, it can:

• • Cause scarring of the corneal surface
  • Induce astigmatism (an uneven curve of the cornea), which can blur vision and require glasses

• In severe, neglected cases, grow over the visual axis (centre of the cornea) and cause significant, sometimes irreversible vision loss

Most patients seen early by an eye specialist at Lowveld Eye Institute will not reach this severe stage, but it’s important not to ignore a pterygium that is clearly enlarging.

Non-surgical treatment and prevention

For small, mildly symptomatic pterygia, we usually focus on:

1. Lubrication and comfort

• Lubricating eye drops (artificial tears)
• Sometimes mild topical steroid drops to reduce inflammation during flares
  • These can help with redness and irritation
  • They do not remove the pterygium

2. Slowing progression: UV protection

Because UV exposure is a major factor:

• Wear good-quality sunglasses that block UV
• Use a wide-brimmed hat outdoors
• Avoid prolonged, unprotected sun and harsh environments where possible

These steps can help slow down growth and reduce flare-ups, especially important for people in sunny regions like Mbombela, Nelspruit and across Mpumalanga.

When is pterygium surgery needed?

Surgery is considered when:

• The pterygium is large or growing steadily
• It is approaching or affecting the visual axis
• It is causing significant astigmatism or visual disturbance
• It is persistently red, inflamed and symptomatic despite drops
• There is a cosmetic concern in combination with any of the above

The procedure is performed by an eye surgeon and is usually done as day surgery.

How pterygium surgery works

The modern standard technique is:

• Removal of the pterygium

1. 1. The fleshy, vascular tissue on the white of the eye and cornea is carefully removed.

• Conjunctival autograft

1. 1. A small piece of healthy conjunctiva is taken from the top part of the eye (under the upper eyelid).
   2. This “autograft” is then placed in the area where the pterygium was removed.

• Securing the graft

1. 1. Historically, fine sutures (stitches) were used to hold the graft in place.
   2. Sutures can cause significant irritation in the early post-op period.
   3. Nowadays, it is more common to use tissue glue (for example, Tisseel) to secure the graft.
   4. Glue generally makes the eye more comfortable after surgery than sutures.

Using a conjunctival autograft significantly reduces the risk of recurrence compared with simply removing the pterygium and leaving the bare area to heal on its own.

What to expect after pterygium surgery

Immediately after surgery:

• The eye will appear red
• Mild discomfort, grittiness or foreign body sensation is common

Over the next days and weeks:

• The area may look yellowish, similar to how a bruise changes colour as it heals
• Redness gradually settles
• The graft integrates with the surrounding tissue

Typical follow-up and care:

• Eye drops (usually anti-inflammatory and lubricating) for several weeks, often 4x per day initially
• Follow-up visit around 4 weeks after surgery to check healing
• Most patients find that by 2–4 weeks, the eye looks and feels much better, with a cleaner, whiter appearance

When should you see an eye specialist?

You should book an appointment with an eye doctor at the Lowveld Eye Institute if:

• You notice a red, fleshy growth on the white of your eye
• The eye is often red, irritated, or tearing
• You feel a scratchy or foreign body sensation
• The growth appears to be enlarging or creeping onto the cornea
• Your vision is becoming blurred, or your optometrist has mentioned astigmatism related to a pterygium

An examination by an eye specialist will determine:

• Whether it is a pinguecula or a pterygium
• How advanced it is
• Whether drops and UV protection are sufficient
• Or whether surgery is advisable

Final thoughts

Pterygium is common in sunny regions like ours and, although benign, it can:

• Be uncomfortable
• Affect the appearance of the eye
• Eventually impact vision if it grows onto the cornea

The good news is that with early assessment and appropriate management, from lubrication and UV protection to modern pterygium surgery with conjunctival autograft, most patients do very well.

If you are concerned about a growth on your eye, speak to an eye specialist at the Lowveld Eye Institute to discuss the best approach for your specific case.