Overview

There are two types of collagen corneal crosslinking- Epithelium-off and epithelium-on corneal crosslinking. Epithelium-off cross linking involves removing the topmost layer of the cornea, the epithelium to allow better penetration of the riboflavin drops. On the other hand, Epithelium-on corneal crosslinking involves leaving the epithelial layer intact during the application of riboflavin. This treatment process is less invasive than epithelium-off and is also called transepithelial crosslinking. But there are other treatment methods like Accelerated corneal crosslinking using UV radiation at an increased rate or contact lens-assisted corneal crosslinking using an ultraviolet barrier-free contact lens soaked with riboflavin for the effects.

A pterygium is abnormal thickening and growth of the tissue (conjunctiva) overlying the white part of the eye (sclera), and extension of this growth onto the cornea.

It is most commonly found on the side of the eye adjacent to the nose, and is often noticed as a redness that is gradually increasing in size.

Causes

Though the exact reason is not known, it is postulated by researchers and scientists that pterygium occurs due to hyperplasticity or excess growth of the limbal epithelial cells along with vascularization or formation of blood vessels over it that gives it its pink appearance.

Healthy conjunctiva and cornea are characterized by a normal limbal area in the cornea and the conjunctiva border. The limbus also contains barrier stem cells that prevent the conjunctival epithelial cells from migrating to the corneal surface. But factors like age, the effect of the sun, especially U.V. radiation, warm or dusty weather conditions, along with a genetic deficiency of these stem cells can cause the barrier to weaken or dissolve. This will lead to the encroachment of the conjunctival cells over the cornea called the pterygium.

Diagnosis of the Pterygium

Before you look for pterygium treatment in London, it is important to first arrive at a conclusive diagnosis about the pterygium. A thorough slit lamp examination can make a diagnosis of the pterygium to check the cornea, conjunctiva, and limbus through a microscope. Fluorescent staining of the eyes and Shimer’s Tests are done at this point as a part of the diagnostic procedures. The aim is to check the level of irregularities and dryness caused due to the pterygium.

During this period, a visual acuity test is done to check the possibilities of astigmatism caused by the invasion of the fleshy pterygium over the corneal surface. If required, Corneal Topography and an occasional biopsy can also be advised by the surgeon to see the status of the cornea along with ruling out cancerous lesions before the surgery. The eyes are photographed as a part of the diagnostic procedure to check the improvement post-surgery.

Phases of Pterygium Treatment

Often a pterygium is deemed cancerous and removed as soon as possible though that is not true. A pterygium is often harmless and stays the same way for almost a lifetime. It is deemed a problem only when it starts encroaching the cornea and crosses the pupillary border, thus affecting our vision. Irrespective of the clinic you visit for pterygium treatment in London, there are usually three treatment modalities for pterygium.
01) Prevention

Exposure to the sun can lead to inflammation of the already inflamed pterygium and worsen the dryness and grittiness symptoms. Taking precautions on being exposed to the inconveniences of the weather, like wearing protective headgear or photochromatic glasses, can prevent the inflammation from getting worse to a great extent.

2) Medication

Pterygium often leads to uneven distribution of the tear film over the eye resulting in dryness and grittiness sensation of the eyes. Additionally, exposure to outside weather tends to inflame the blood vessels causing redness with foreign body sensation with occasional watering sensation. Antibiotics and corticosteroids help in the treatment of the inflammation to a great extent and help provide symptomatic relief to the patient. Use of Non-Steroidal-Anti-Inflammatory-Drugs ( NSAIDs), i.e., a group of medications with anti-inflammatory effects minus the side effects of steroids, is highly recommended in pterygium patients for long-term use of reducing the inflammation. Additionally, lubricating medications provide immense relief by lessening the dryness caused by the uneven surface of the globe. In this regard, you can always talk to an expert ophthalmologist from A.I. Vision, London, if you want to avoid the surgery and look for an alternative way to treat the condition.

3) Surgery

Pterygium Surgery involves the removal of the pterygium using general anesthesia. Surgery is only recommended if the risk of corneal scarring and vision loss due to the progression of the pterygium is high. It involves surgically removing the eye and transplanting some of the conjunctivae from the upper portion of the eye to the removal area as a part of the treatment procedure. Pterygium Surgery can be done either through the Conjunctival Autograft method using stitches post-treatment or No-Stitch Autograft Surgery that uses modern adhesive tissue instead of stitches. That's why you must be very careful at choosing an ideal clinic for your pterygium removal in London. The healing takes 3-4 weeks with minor discomfort. You will be advised to regular use of medications to minimize the discomfort. The scarring over the cornea usually fades in 5-6 months on proper care. In this regard, if you need a trusted clinic for pterygium removal in London, Harley Vision would be your ideal bet. We have a high success rate because highly experienced ophthalmologists perform the surgery. We use the latest state-of-the-art treatment modalities to make the whole process easy and hassle-free for you.

Do you need surgery?

You will not need surgery until and unless the encroachment crosses the pupil and starts affecting the vision of the eye. There is always the risk of the pterygium reappearing with increased intensity post surgeries, even if you go for the best pterygium surgery in London. That’s why there used to be a time when even top surgeons of London used to avoid the surgery to the max limit. But thanks to the modern Autograft method, the recurrence area of the pterygium is filled, thus preventing any chances of further growth. You might also need surgery if the risk of corneal scarring is greater or if there is too high irregular astigmatism because of the growth making surgical treatment an inevitable option. It’s better to take collective advice from two or three expert clinics good at pterygium removal in London with good reviews to claim their proficiency.

Can you prevent it?

Unfortunately, pterygium formation’s exact mechanism is not known because preventing it from occurring is not a feasible option. But maintaining a healthy eye from the start can prevent the chances of pterygium formation to a great extent. Maintaining a balanced diet and drinking sufficient water can ensure the health of your eyes to a great extent. Sincerely wearing protective eyewear outside of the house can reduce the occurrence chances of the pterygium and halting its progress if it has already started. But most importantly, regular eye check-ups can give a clear idea to the surgeon about the progression of the tissue. This will help him excise it at the right moment with minimal corneal scarring and optimum vision recovery post-surgery. 

Taking care of the risk factors

Sun, radiation effects, U.V. radiation, pollen, and genetic factors are the most important risk factors for Pterygium formation. Wearing good-quality sunglasses can minimize the risk of sun damage to a great extent.

Avoiding the radiation causing agent or full face protection can take care of the radiation factors leading to the formation of radiation. Prolonged use of computers can cause the computer system-induced U.V. radiation to cause dryness, thus further increasing the pterygium discomfort.

Using an anti-reflection coating while sitting in front of the computer for prolonged periods can take care of the issue. Pollen can lead to allergic reactions causing itching, which can increase inflammation. Using antihistamines along with avoiding the source of allergies can sort these particular risk factors. We don’t have any control over the genetic factors. But a regular check-up can make the symptoms known from an early period which can help in better treatment of the problem. You can get in touch

Frequent asked questions (FAQs):

This condition is very common in people who are persistently exposed to excessive sunlight (i.e. UV light). It is more frequently seen in those who have lived in sunny areas of Far East Asia, Central Asia, Middle East, Africa and South America.
A pterygium will result in a triangular pink bump on the white bit of the eye, and can grow onto the clear window of the eye (cornea). It can cause intermittent irritation and redness. A pterygium can worsen eyesight by growing onto the central cornea, or by altering the shape of the eye surface (astigmatism).
A pterygium is diagnosed by clinical examination during your clinic consultation. This is important to help differentiate a pterygium from similar more rare conditions. Occasionally, a sample may need to be sent to the lab to rule out more serious causes.

Often a pterygium will not require treatment. Intermittent irritation and redness is often successfully treated with lubricating eye drops (artificial tears).

Occasionally, a short course of steroid eye drops is used if there is significant inflammation.

Surgery is an option when the pterygium interferes with vision, causes persistent inflammation or is making the eye appear abnormal.

Surgery is most frequently performed under local anaesthesia, but can be performed under sedation or general anaesthesia. The eye is usually sore and red after the surgery. Using the drops prescribed by your doctor after surgery is important to minimise risk of infection and inflammation.

A pterygium can recur after surgical removal. However, modern techniques in pterygium surgery have significantly reduced the recurrence rate from almost 90% down to about 5-10%.

The rate of recurrence is influenced by several factors. For example, it is much higher when removing a recurrent pterygium (one which was operated on before), or in certain ethnic groups (e.g. Hispanics).

Pterygium can cause severe corneal scarring and the resulting decrease in vision if not treated timely. Timely treatment of the condition reduces the chance of scarring and vision loss to a great extent. Regular screening can also help in the early identification of the problem and help in its subsequent treatments.
Pterygium and Cataracts are two completely different terms. A Pterygium is a tissue growth over the conjunctiva, a thin transparent membrane over the white portion of the eye. At the same time, a cataract is the opacification of the lens, which is the refractive surface of the eye helping in vision. A Pterygium does not need removal because it does not usually interfere with the vision, but a cataractous lens from the starting interferes with vision making its removal pertinent.
Pterygium Surgery is a minimally invasive procedure and takes not more than 30-40 minutes. Most clinics in London would advise you for local or general anesthesia, depending on the type of surgery you’re opting for. You will be required to fast or eat very light meals 12 hours before the surgery to enable the anesthetics to set in effectively. Post-surgery, you can go home on the same day but will need someone to drive you home.
You can rejoin normal work in a few days after the surgery but will be required to refrain from heavy exercising along with swimming or taking saunas. You can take showers but will have to avoid getting water or shampoo inside your eyes. You will also need to avoid eye makeup for a few days post-surgery, along with using protective eyewear on stepping out of the house.
Most insurance companies in London cover for the cost of pterygium surgery only when the pterygium crosses the pupillary margin of the eye and starts interfering with the vision. However, they may not cover the cost of the surgery if the pterygium has not yet touched the Corneal margin and is being removed only for cosmetic issues.
Irrespective of the clinic you visit for pterygium surgery in London, the cost will vary depending on a lot of factors. For example, it depends on the size, thickness and the number of pterygiums as there is a chance of bilateral pterygiums with more than one growth in each eye. It also depends whether you have enough natural tissue for the graft or not. If the clinic is in the central area of London and has experienced doctors for the surgery, the cost may go up. In case, you want to know an approximate cost of your pterygium surgery, get in touch with Harley Vision in London, today.