A pinguecula is a common, non-cancerous growth that develops on the conjunctiva, which is the clear, thin membrane covering the white part of the eye. This yellowish, slightly raised bump is typically found on the side of the eye closer to the nose, though it can occur elsewhere. The formation of a pinguecula is strongly linked to long-term exposure to environmental factors like ultraviolet (UV) radiation from the sun, wind, and dust, causing changes in the underlying tissue that involve deposits of protein, fat, and calcium.
Managing Symptoms Without Surgery
For most people, a pinguecula causes few or no symptoms. When the growth becomes irritated, a condition known as pingueculitis, it can become red, swollen, and cause a feeling like a foreign body is in the eye. The initial approach to managing these flare-ups is conservative, focusing on relieving inflammation and dryness.
The most common treatment involves the consistent use of lubricating eye drops, often called artificial tears, which help to moisten the eye’s surface and reduce friction over the raised bump. These drops can minimize the dryness and irritation that often trigger a symptomatic episode. For temporary but significant inflammation, a doctor may prescribe a short course of mild non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroid eye drops. These medicated drops quickly reduce the redness and swelling associated with pingueculitis.
Protecting the eyes from further environmental damage is a fundamental part of long-term management and prevention of progression. Patients are strongly advised to wear high-quality sunglasses that block 100% of UVA and UVB rays whenever outdoors, even on cloudy days. Wraparound styles offer the best protection by shielding the eyes from wind and dust, which are known irritants that exacerbate the condition. By controlling environmental triggers and maintaining lubrication, the need for more invasive procedures is often avoided.
Criteria for Surgical Removal
Surgical removal is an option reserved for specific situations where conservative treatment has failed. A doctor will only recommend excision when the growth is causing significant, persistent problems. One primary indication is severe, chronic inflammation that does not resolve with repeated courses of anti-inflammatory or steroid drops.
Removal is also considered if the pinguecula progresses into a pterygium, which is a growth that extends onto the clear cornea. Since a pterygium can directly interfere with vision by covering the pupil or causing significant astigmatism, removal may be performed preemptively to prevent this outcome. Surgery is also considered if the size of the growth interferes with the proper fitting or comfortable wear of contact lenses. Patients may also opt for removal for cosmetic reasons if the lesion is highly noticeable.
The Removal Procedure and Recovery
The surgical removal of a pinguecula is a straightforward outpatient procedure typically performed under local anesthesia. The surgeon carefully excises the abnormal tissue from the surface of the sclera, the white part of the eye. The entire procedure is often completed within 20 to 30 minutes.
Modern surgical techniques prioritize the use of a conjunctival autograft to cover the area where the pinguecula was removed. This involves taking a small piece of healthy conjunctiva from another part of the patient’s eye, often from under the upper eyelid, and transplanting it over the excision site. The graft is typically secured using a fibrin tissue glue, which eliminates the need for sutures and can significantly reduce post-operative discomfort. This grafting method acts as a barrier to prevent the lesion from growing back, lowering the risk of recurrence.
Following the surgery, patients can expect the eye to be sore or gritty for the first three to five days. Medicated eye drops, including a combination of antibiotics and steroids, will be prescribed for several weeks to prevent infection and control post-operative inflammation. While many patients can return to work or normal activities within one or two days, the eye may appear quite red for four to six weeks as the healing process continues. The careful use of grafting techniques leads to a much smoother, more natural post-operative appearance, minimizing the cosmetic impact of the removal.