double pterygium

Double Pterygium: A Rare Corneal Condition

A double pterygium, also known as a double-headed pterygium, is a rare benign fibrovascular overgrowth that affects the nasal and temporal bulbar conjunctiva onto the cornea. This condition is characterized by the presence of two separate pterygia, one on each side of the eye, which can cause discomfort, blurred vision, and other symptoms.

Key Features:

• A double-headed pterygium is a rare type of pterygium that affects both the nasal and temporal parts of the cornea.
• It is caused by chronic ultraviolet light exposure, similar to single pterygia.
• The condition can cause discomfort, blurred vision, and other symptoms due to the growth of fibrovascular tissue onto the cornea.

Treatment Options:

• Surgical excision with conjunctival autografting is a common treatment option for double-headed pterygium.
• Amniotic membrane grafts may also be used in addition to conjunctival autografting.
• In some cases, additional measures such as mitomycin-C application or laser therapy may be necessary to prevent recurrence.

Prevalence and Causes:

• Double-headed pterygia are relatively rare compared to single pterygia.
• The exact prevalence of double-headed pterygium is unknown, but it is estimated to occur in a small percentage of cases.
• Chronic ultraviolet light exposure is the primary cause of pterygium, including double-headed pterygium.

References:

• [1] T Röck (2020) - Double-headed pterygia are a rare benign fibrovascular overgrowths of the nasal and temporal bulbar conjunctiva onto the cornea.
• [2] BE Kurtul (2020) - Pterygium is a frequent corneal disease characterized by growing of fibrovascular tissue from the bulbar conjunctiva onto the cornea.
• [3] SK Kodavoor (2017) - A pterygium is an ocular surface fibrovascular, wing-shaped encroachment onto the cornea associated with chronic ultraviolet light exposure.

Double Vision and Pterygium

Pterygium, also known as surfer's eye, can cause a range of symptoms, including blurred or double vision. When both eyes are affected by pterygium, the symptoms can be more pronounced.

• Blurred or Double Vision: One of the most common symptoms of pterygium is blurred or double vision. This occurs when the growth on the cornea affects the way light enters the eye, causing the image to appear distorted or duplicated (1, 4).
• Vision Disturbance: As the lesion progresses, it can cause significant vision disturbance, including astigmatism or obscuration of the visual axis (2, 5).
• Redness and Irritation: In addition to vision problems, pterygium can also cause redness and irritation in the eyes. This is due to the growth's effect on the tear film and localized inflammation (3, 6).

Symptoms of Double Pterygium

When both eyes are affected by pterygium, the symptoms can be more severe and may include:

• Severe Blurred or Double Vision: The combination of two pterygia can cause significant vision problems, making everyday activities challenging.
• Increased Redness and Irritation: With two growths on the cornea, the redness and irritation in the eyes can be more pronounced.
• Decreased Visual Acuity: In severe cases, double pterygium can lead to decreased visual acuity, making it difficult to perform tasks that require clear vision.

It's essential to seek medical attention if you experience any of these symptoms. A comprehensive eye examination by an ophthalmologist or optometrist can diagnose pterygium and determine the best course of treatment.

References:

[1] - Context result 4 [2] - Context result 10 [3] - Context result 7 [4] - Context result 5 [5] - Context result 6 [6] - Context result 13

To diagnose double pterygium, which refers to pterygium growth on both the nasal and temporal sides of the same eye (context [13]), a detailed physical examination using a slit lamp is typically performed by an ophthalmologist. This examination allows for close-up observation of the lesion under magnification.

In addition to the physical examination, no special tests are necessary for diagnosing double pterygium. The diagnosis can be made based on the presence of pterygium growth on both sides of the eye (context [11]).

It's worth noting that while a detailed history is taken as part of the diagnostic process (context [12]), there is no evidence to suggest that primary pterygium causes changes in laboratory blood tests. However, studies have been reported about the changes in the conjunctival sac of patients with primary pterygium, including an increase in certain factors.

The clinical management guidelines for pterygium provide information on the diagnosis and management of this eye condition (context [14]), which may present in primary and first contact care.

Based on the provided context, it appears that there are various treatment options for double pterygium, including surgical and non-surgical methods.

Non-Surgical Treatments

• Anti-inflammatory drops such as topical steroids can be used to treat any redness and inflammation caused by the pterygium [7].
• Artificial tears (eye drops) or ointments with corticosteroids can be used to reduce inflammation and alleviate discomfort. Long-term and frequent use of artificial tears is recommended [8][9].

Surgical Treatments

• Surgical treatment with superior conjunctival autograft is a type of treatment for various ocular disorders, including double pterygium. This procedure involves using a small portion of the patient's own conjunctiva to cover the affected area [11].
• Adjunctive treatment post-surgery includes conventional immunosuppressants as well as antiviral drugs. The use of large- and small-molecule antivascular endothelial growth factor (VEGF) agents remains an integral part of pterygium treatment [12].

Adjuvant Treatments

• Mitomycin C (MMC) has been used as a fibroblast proliferation inhibitor during surgery to reduce the chance of recurrence of the pterygium [2].
• Anti-fibroproliferative application with 5-fluorouracil or mitomycin C may be a useful adjunct in primary pterygium surgery, including double-headed pterygium [5].

It's worth noting that surgical removal is often considered the main treatment for pterygium, and adjuvant treatments like MMC may be used to reduce recurrence rates. However, non-surgical treatments such as artificial tears and anti-inflammatory drops can also provide relief from symptoms.

References: [2] - Mitomycin C has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium. [5] - Anti-fibroproliferative application with 5-fluorouracil or mitomycin C may be a useful adjunct in primary pterygium surgery [28, 29]. [7] - Anti-inflammatory drops such as topical steroids can be used to treat any redness and inflammation caused by the pterygium. [8] - Most pterygiums can be treated using artificial tears (eye drops) or ointments with corticosteroids. [9] - Long term and frequent use of artificial tears is recommended [University Pharmacy, University ...]. [11] - Surgical treatment with superior conjunctival autograft is a type of treatment for various ocular disorders; however, in 1985, Kenyon et al. adapted this procedure for advanced primary pterygium and recurrent pterygium. [12] - Adjunctive treatment post-surgery includes conventional immunosuppressants as well as antiviral drugs. The use of large- and small-molecule antivascular endothelial growth factor (VEGF) agents remains an integral part of pterygium treat …

Differential Diagnosis of Double Pterygium

Double pterygium, also known as bilateral pterygium or double-headed pterygium, is a rare type of pterygium that occurs in both eyes simultaneously. The differential diagnosis for double pterygium includes various conditions that may present with similar symptoms and characteristics.

• Pseudopterygium: A condition where the conjunctiva appears to be growing onto the cornea, but it's actually an inflammatory reaction rather than a true pterygium [3].
• Pinguecula: A small, yellowish or brownish growth on the conjunctiva that can be mistaken for a pterygium [3].
• Pannus: A condition where the conjunctiva grows onto the cornea, but it's not as severe as a pterygium [3].
• Episcleritis and Sclerokeratitis: Inflammatory conditions of the episclera (the thin layer of tissue covering the white part of the eye) and sclera (the white part of the eye), which can be mistaken for a pterygium.
• Conjunctival and Corneal Lesions: Other types of lesions, such as conjunctival cysts or corneal ulcers, that may present with similar symptoms to double pterygium.

It's essential to note that double pterygium is a rare condition, and its diagnosis requires a thorough examination by an eye care professional. A slit lamp exam can help differentiate between these conditions and confirm the presence of a double pterygium [5].

References: [3] - Pterygium usually occurs due to chronic ultraviolet exposure and develops at the nasal part of the cornea (97%) [3]. [5] - Your eye care provider can diagnose a pterygium with a slit lamp exam. A slit lamp is a type of microscope that focuses a narrow beam of light onto the eye, allowing for detailed examination [5].