Photo Quiz

A Lesion on the Eye


Am Fam Physician. 2018 Mar 1;97(5):337-338.

A 33-year-old woman presented with a growth on her eye that had been present for several years. She believed that it had grown over the previous six to eight months. She was asymptomatic other than seasonal pruritus, especially during the summer. There was no localized pain, discharge, or vision changes.

Physical examination revealed a small, clear corneal growth on the left eye that extended medially toward the pupil (Figure 1). There were no abnormal findings on neurologic examination.

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Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Conjunctival neoplastic lesion.

B. Conjunctivitis.

C. Episcleritis.

D. Pinguecula.

E. Pterygium.


The answer is E: pterygium. The pterygium is a triangular wedge of soft, nearly flat fibrovascular conjunctival tissue that starts medially on the nasal conjunctiva and extends laterally onto the cornea.1 It is white and amorphous or thick. It may have redness or irritation. The lesion usually is not noticed unless it appears white against a colored iris or red because of a vascular component. It is typically bilateral but may be unilateral.

Pterygium is usually asymptomatic but may cause mild visual impairment. It can extend onto the cornea and impair vision through induced astigmatism. If the lesion is larger than 3.5 mm (greater than halfway to the center of the pupil in a typical cornea, 11 to 12 mm), it will cause blurriness. Pterygium can restrict eye movement if the inflammation causes the conjunctiva and overlying eyelid to stick together. Pterygium may be caused by chronic exposure to ultraviolet light.2 The prevalence of pterygium varies from 1% to 25%.3 Treatment depends on the size. A small pterygium may be treated symptomatically with artificial

Address correspondence to Helen Cann, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Shtein RM, Sugar A. Pterygium and conjunctival degenerations. In: Lang GK, Craubart Champe G, eds. Ophthalmology. 3rd ed. New York, NY: Stuttgart; 2014....

2. Lim CY, Kim SH, Chuck RS, Lee JK, Park CY. Risk factors for pterygium in Korea: the Korean National Health and Nutrition Examination Survey V. Medicine (Baltimore). 2015;94(32):e1258.

3. Lucas JT, Green GM. Pterygia. In: Burk RL, King GK, eds. Clinical Radiation Oncology. 4th ed. Philadelphia, Pa.: Elsevier; 2016.

4. Harissi-Dagher M, Colby K. Tumors of the cornea and conjunctiva. In: Albert DM, Miller JW, eds. Albert and Jakobiec's Principles and Practice of Ophthalmology. 3rd ed. Philadelphia, Pa.: Saunders/Elsevier; 2008.

5. Folberg R. Pinguecuala and pterygium. In: Kumar V, et al., eds. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, Pa.: Elsevier; 2015.

6. Guluma K, Lee JE. Treatment of pterygium and pinguecula. In: Walls RM, Hockberger RS, Gaushche-Hill M, Bakes KM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

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