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ARTICLES
Year : 1977  |  Volume : 25  |  Issue : 1  |  Page : 37-38

Cystic degeneration of the pterygium


Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondieherry-6, India

Correspondence Address:
Shashi Kapoor
Department of Ophthalmology, J.I.P.M.E.R., Pondicherry-6
India
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Source of Support: None, Conflict of Interest: None


PMID: 612591

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How to cite this article:
Kapoor S, Sood G C, Aurora A L, Kapoor MS. Cystic degeneration of the pterygium. Indian J Ophthalmol 1977;25:37-8

How to cite this URL:
Kapoor S, Sood G C, Aurora A L, Kapoor MS. Cystic degeneration of the pterygium. Indian J Ophthalmol [serial online] 1977 [cited 2020 Apr 1];25:37-8. Available from: http://www.ijo.in/text.asp?1977/25/1/37/34600

Pterygiurn is a degenerative condition which presents as a fleshy growth on the nasal side of bulbar conjunctiva. Pathologically it is a prolife­ration of the subconjunctival tissues as vascula­rized granulation which has a tendency to invade the cornea . [3] It runs, usually [4] a benign course; sometimes its epithelium can undergo a malig­nant transformation [3] and its stroma a cystic change. [1],[5]

The object of the present communication is to report two cases of pterygium with cystic de­gneration and discuss their pathogenesis.


  Case Reports Top


Case I

A 35-year-old man presented with a horizontally oval cystic swelling measuring 8 x 3 mm in the body of the nasal pterygium in left eye [Figure - 1]. The cyst was there for the last 6 months and was stationary in its size. The cyst could be moved freely and was free from the the deeper structures. The pterygium was pale and no blood vessel could be seen on the cyst. The swelling was painless and nontender. There was no history of any prior inflammatory episode in this eye. The ocular movements were normal and the preauricular lymph nodes were not palpable.

The whole of the pterygium was excised; a part of the sclera was left bare and the cornea was cauterized. The mass was subjected to histopathological examina­nation. Microsocopic examination revealed a cyst lined with stratified squamous epithelium in the stroma of the pterygium. The cyst had lot of cellular debris in it and a mild inflammatory reaction was surrounding the cyst all-round [Figure - 2].

Case II

A 45-year-old man presented with a swelling on the temporal limbus of the left eye for 4 months. An exami­nation of the left eye showed a globular cyst measuring 1 x I x 0.6 cm in the body of a thin, avascular, and atrophic temporal pterygium. The cyst was free from the deeper structures; it could be moved in the vertical direction. The ocular mobility was normal. The his­tory of any inflammatory attack in this eye was lacking [Figure - 3].


  Discussion Top


The conjunctival cysts can be of vari­ous varieties [3] , i.e., epithelial implantation, parasitic, glandular retention and lym­phatic. The cysts in the pterygium are believed to follow an inflammatory re­action [1] in the stroma of the pterygium which result in down-growth of the surface cylindrical cells, the central core of which undergoes a degenerative change to form cystic cavities. The cysts can be unilocular or multilocular depend­ing upon the number of places the down-grow­ing cells undergo degeneration. Also. the cysts can be congenital in origin when they are deep to the pterygium and fixed to the deeper structures [5] .

The free mobility and non-adherence of the cysts to the deeper structures are suggestive of the acquired origin of cysts in our cases.. A mild reaction in the pterygium, in the absence of an inflammatory episode, is an insufficient proof of the inflammatory origin of the cysts. The inflammatory reaction in the pterygium can result from the pressure effect of the cellu­lar debris in the cysts, though a mild inflamma­tory reaction in the pterygiurn is considered. Normal [3] . The intact epithelial lining of the pterygium is another proof against the infla­mmatory origin, where the lining is expected to be disorganized. The cysts, thus appear to be the result of cellular down-growth following primary degeneratsive changes in the stroma of the pterygium rather than an inflammatory episode, as is conjectured.


  Summary Top


Two cases of pterygium with cystic degene­ration are described. The inflammatory hy­pothesis of their origin is refuted and primary degenerative phenomenon is held responsible for the cystic changes in the pterygium.

 
  References Top

1.
Bistic, J., 1921, Arch. Ophthal. (Paris), 38,277.   Back to cited text no. 1
    
2.
Boniuk, M., 1970, Survey Ophthal., 14,457.  Back to cited text no. 2
    
3.
Duke-Elder, S, and Leigh, A.G., 1965, Sys. Of Ophtha, 3, 573.  Back to cited text no. 3
    
4.
Kamel, S., 1955, Bull. Ophthal.Soc. (Egypt), 48,99.  Back to cited text no. 4
    
5.
Mathur, S. P., 1959, Brit. J., Ophthal., 43,763.  Back to cited text no. 5
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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