Primary Pterygium When Conservative Symptomatic Treatment Has Not Relieved Foreign Body Sensation

Clinical Scenario

This protocol covers primary pterygium in patients who have not previously undergone pterygium excision and whose symptoms — notably persistent foreign body sensation — have not responded adequately to conservative management.

Why this step is indicated — prior treatment and its outcome

The initial approach — conservative symptomatic treatment (artificial tears, non-preserved lubricant eye ointment, and short-term anti-inflammatory eye drops for inflamed pterygia) — did not achieve its primary target: relief from foreign body sensation in the eye. Failure to reach this goal is the clinical trigger for escalation to a more definitive intervention.

Next-Step Treatment Approach

The main method of treating a pterygium is surgical excision. For primary pterygium, excision is combined with adjuvant chemotherapy — a class of agents applied to reduce the risk of recurrence — and in some cases an additional corticosteroid preparation is used alongside.

Agent selection, intraoperative technique, and the full structured regimen are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.4103/1596-3519.84695

The main method of treating a pterygium is by surgical excision.
At the present state and as first line treatment, it would seem reasonable for ophthalmologists working in resource limited settings to use adjuvant chemotherapy such as MMC or 5FU and in some cases with additional depot steroid as treatment for primary pterygium.
Risk factors for the recurrence phenomena of pterygia are not distinctively known but there is a higher risk of recurrence after re-excision of a recurrent pterygium compared to a primary pterygium.

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