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.
Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?
A. Conjunctival neoplastic lesion.
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
Referencesshow 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.
A collection of Photo Quizzes published in AFP is available at http://www.aafp.org/afp/photoquiz.
Previously published Photo Quizzes are now featured in a mobile app. Get more information at http://www.aafp.org/afp/apps.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to firstname.lastname@example.org.
Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions