The “2-Ps” - Pingecula and Pterygium - and Dry Eye Disease…

Do you have a pinguecula? If you are beyond your teenage years and have spent any time outdoors in the sun and the wind without a good pair of sunglasses, then there is an excellent chance that you do (this condition is frequently called “Surfer’s eye” since surfers obviously spend a lot of time in the wind and sun, but anyone can get this without having to surf). If you have dry eyes, then this is certain to make this problem worse. I’ll paste a link to pictures and information from the American Academy of Ophthalmology regarding this common problem at the end of this posting, but will give you my “street version” generated from over 30 years of clinical experience, first. 

The sun’s UltraViolet Light (UV) will damage skin that can lead to premature aging - causing  fine lines, wrinkles and even deeper furrows - along with an increased risk of skin cancers - on your face (or anywhere else the sun can shine). The same UV will also lead to damage of the smooth, clear, moist membrane over the white part of your eye, called the conjunctiva. A scar-like repair follows, that deposits proteins, fats (the yellow) and sometimes calcium (like in bones and teeth). As this yellowish “bump” or lump appears, it behaves like a small island, sticking up out of the pool of tears which otherwise moisten and support this membrane. This yellowish lump or bump on the white of an eye is called a pingegula - and by itself, is of little consequence unless it becomes dry, irritated, inflamed (red) or grows very big (see below). Think of it as more of a “red flag” to call attention to sun damage and dry eye disease - since both are common causes that can do more harm than “just a little yellow spot,” visible on the white of the eye.

Poor tear volume, poor tear quality (especially poor oil - so less lubrication and greater evaporation) - or - common to many dry eye patients- both problems - will contribute to further damage and promote increasingly active, scar-like repair. As the “scar” increases, it tends to grow into the cornea (the clear, front part of the eye). At this point, it is called a pterygium and with continuing growth, it can cause increasing irritation and even eventually jeopardize vision.  While surgery is an option at any stage, it becomes increasingly necessary as the pterygium threatens to cover the pupil (where light enters the eye), potentially blocking light from coming in - but even when not directly in the path of light - it can disturb the light by bending the light rays like a prism and creating a “circus mirror-like effect,” called astigmatism..

Unfortunately, healing with bad tears and dry eyes will usually promote more scarring, leading to a potential recurrence of the pterygium. Further surgery begets more white scarring and can lead to permanent damage to the otherwise clear cornea. Prevention is key to avoiding the larger lumps that can be very obvious to the naked eye observer, even if they don’t impair the vision of the affected eye. This means wearing quality sunglasses outdoors - but also means taking care of dry eye disease. Artificial tears, topical steroids and other anti-inflammatories (like Restates and Xiidra) may be prescribed by an eye doctor to treat an irritated pinguecula or growing pterygium, but unless coupled with sunglass protection while targeting whatever is wrong with the cells and glands making tears, this can be another case of “kicking the can down the road” - where the basic problem(s) causing the pingecula or pterygium are not being addressed.

Before cataract surgery, it is necessary to get a “good read” on the curvature of the cornea. This is because the cornea provides 2/3 of the focusing power of the eye - so the lens implant replacing a cataract has to be the “fine tuning;” providing the final 1/3 power required for optimal focusing and for the best vision independent of glasses after cataract surgery. If any irregularity of the cornea’s surface - such as a pterygium - can change its size and shape over time (like a pterygium), then dealing with that before cataract surgery can have a big impact on determining the best implant power for the future vision correction. Dry eyes can cause an irregular surface, too (from dry, irregular, dead and dying cells on the corneal surface). THIS VISION CAN LITERALLY CHANGE WITH EVERY BLINK - so dry eyes commonly can cause intermittent, blurry vision - but also make it hard to get a good read on the corneal surface (or even to get a good refraction for glasses). Combining a dry eye with a pterygium is a type of “double whammy” where dryness can aggravate the pterygium - but also cause its own unique issues with vision and cataract surgery. All the more reason to consult a dry eye specialist when you are found to have either of the two P’s - or dry eye disease!

https://www.aao.org/eye-health/diseases/pinguecula-pterygium