|Year : 1983 | Volume
| Issue : 2 | Page : 61-63
Changes in pterygium
Vasudev Anand Rao
Jawaharlal Institute of Post Graduate Medical Education & Research Pondicherry, India
Vasudev Anand Rao
Assistant Professor of ophthalmology, Jawaharlal Institute of Post Graduate Medical Education & Research Pondicherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rao VA. Changes in pterygium. Indian J Ophthalmol 1983;31:61-3
Pterygium is essentially a triangular encroachment of the bulbar conjunctiva on to the cornea. Secondary changes such as cyst formation.,,,, calcareous degeneration, and neoplastic growths,,,,, are relatively rare.
The purpose of the present communica. tion is to describe such changes in pterygium.
| Observations|| |
Summary of the important features in these 6 cases is given in [Table - 1] and [Figure - 1] and[Figure - 2].
| Discussion|| |
The fully developed pterygium is covered by conjunctival epithelium, stratified with flat cells on the surface of the head and neck, but cylindrical in the numerous folds and furrows at the base. In the depression goblet cells are numerous and in the body of the pterygium tubular downgrowths of cylindrical cells from glands which may develop into cysts.  The cysts can be congenital in origin when they are deep to the pterygium and are fixed to the underlying structures. Goel et. al. have described the formation of a cyst in a pterygium following trachoma. According to Kappor et. a1. the cysts appear to be the result of cellular downgrowth following primary degenerative changes in the stroma of the pterygium. In case No. I the pterygium was thin and anaemic. The cyst could be moved with the conjunctiva and was found within the stroma of the pterygium. There was no inflammatory reaction. Therefore cyst formation in this case too appears to be the result of a degenerative process. In case No. 2 there was history of trauma with finger nail and histopathological examination showed a cyst lined by stratified squamous epithelium and it contained clear fluid. During trauma the surface epithelium was carried into the body of the pterygium and this subsequently gave rise to a cyst. Boniuk also described a ptergium with opithelial inclusion cyst. In his case examination of the cyst contents revealed budding yeast forms and septate mycelia. According to him these saprophytic conjunctival organisms were carried along with the surface epithelium during the initial trauma,
Case No, 3 and 4 showed cystic degeneration of pteygium. In addition there was secondary or dystrophic calcification in the sub-epithelial layer.
Inspite of its high recurrence rate of 30 to 50% after excision, only a few reports are available of neoplastic growth developing in a pterygium. Among these are epitheliomata,, naevij, malignant melanoma sub and fibroblastic sarcoma. Epithelioma of the conjunctiva commonly occur at the limbus where two types of epithelia merge together. In case No. 5 too it occurred in the head and neck of the pterygium which were overlying the limbus. Repeated operative trauma may also play some part in the development of neoplasm in pterygium. The clinical feature, suggestive of malignancy in our case were the elevated mass, reddish grey colour. granular appearance and vascularisation. In all such cases a wide local excision should be done and the growth sent for histopathological examination. Epithelioma rarely penetrate the sclera. In the present case the underlying sclera was found intact at operation.
In case No. 6, which showed junctional naevus, the naevus cells were confined to the basal layer. The purpose of excision of the pterygium with the naevus was three fold.
(1) To improve the vision
(2) Cosmetic purpose
(3) Conjunctival naevi are more likely to become malignant than naevi encountered at most other sites.
According to Jay an active junctional naevus must be considered to be of more ominous significance. Activity is characterised by the upward migration of the naevus cells, by pleomorphism of cells, by loss of cohesion between the individual cells and by the presence of mitotic figure. These features were absent in the present case and the prognosis therefore appears to be good.
| Summary|| |
Six cases of pterygium with secondary changes are reported here. Four had developed cysts underneath, one sqynamous cell carcinoma, and one had junctional naevus with in the pterygium.
| References|| |
Kamel. S., 1955. Bull. Ophthalmol Soc. Egypt. 48 : 99
Mathur S.P.. 1959, Brit. .1. Ophthalmol. 43 : 763
Goel I.B., Sethi, P.K., Shukla, S.M., and % Tonga L N, 1973, Orient. Arch. Ophthalmol 9 : 119.
Kappor, S. Sood, G.C., Aurora, A.L. ; and Kapoor, M, 1977. Ind. J. Ophthalmol. 25, 1, 37.
Boniuk M. 1970-Survey Ophthalmol. 14 : 457
Kamel's, 1946, Brit. J. Ophthalmo1 30 :549
D'Ombrain. 1948, Brit. J. Ophthalmol 32: 65
Selecka, 1955, Csl. Ophthalmol 11 : 293
Mathur, 1959, Ophthalmologica 137: 320
Claus, 1943, Klin Mol. Augenheilk 109 : 59
Marin-Amat. and Marin Enciso (1948)* Arch. Soc. Ophthalmol Hisp. Amer. 8 : 839.
Aubaret, 1923. Clin. Ophthalmol. 27 :250.
Rapisarda, 1947, Atti. Cong. Soc. Ophthalmol. Ital. 36:575
Duke-Elder S.S., 1967, System of Ophthalmology Vol. VIII page 575 to 580 Henry Kimpton, London
Hogan, M.J. and Zimmerman, L.E., 1962, Ophthalmic. Pathology, An atlas and Text Book p. 262, W.B. Saunders, Philadelphia.
Reese A.B, 1963, Tumors of the Eye, 2nd edn. Harper and Row, New York.
Jay Barrie, 1965. Brit..1. Ophthalmol 49 : 169.
[Figure - 1], [Figure - 2]
[Table - 1]