Pterygium Removal

Introduction

A pterygium is a benign growth of the eye's conjunctiva thought caused by excessive and prolonged exposure to ultraviolet light, low humidity, dust and other eye irritants. 

I had a pterygium in my eye for over 10 years until last year when I had it surgically removed. I wrote this as a personal account of what it's like having pterygium surgery and the associated costs and issues that go along with it. It is not intended to provide medical advice but hopefully it will be of interest or help to those considering pterygium surgery.

Personal Background

I grew up in a seasonally hot and dry climate and spent a considerable portion of my youth surfing and participating in outdoor activities. Such conditions are conducive to development of pterygium's and yet none of my friends or family have ever had pterygiums. I probably have some predisposition and this combined with the environmental and lifestyle factors led to my developing a pterygium.

I first noticed a small raised spot on the white of my eye and had no idea what it was. It certainly didn't look anything like the wedge-like growth which starts on the nasal side of the eye and grows toward the pupil which typically characterizes a pterygium.

The first GP I saw about this spot diagnosed it as a pterygium and simply prescribed some eye drops. He also advised that as it wasn't interfering with my vision and didn't pose any other immediate risks, it was best left alone. This set the tone for advice I received over the next 10 years. Whenever I visited a doctor or optometrists they would invariably notice my pterygium and say the same thing i.e. 'if it's not interfering with your vision or causing you any discomfort, and if it doesn't pose any greater risks, it's best to leave it alone.'

This is how my pterygium looked roughly 4 years after I first noticed it (8 years before I had surgery to remove it):












Finally last year an optometrist referred to me to an ophthalmologist. The optometrist deemed my pterygium sufficiently large to warrant a specialist examination.This proved good advice.

The ophthalmologist advised it was starting to grow over my pupil and could impair my vision. In fact by this time if my pupil was fully dilated the pterygium would already cover my pupil by half a millimeter or so (although I don't recall it affecting my vision).

At this stage it was also becoming quite unsightly, particularly so when my eyes were irritated and red which would make it quite visible and occasionally lead to people asking questions. 

Pterygium Surgery

My ophthalmologist explained the risks of not removing the pterygium, the main one of which was that it could start to impair my vision. It was also at the critical stage where if I chose not to remove it and it got larger, it would make surgery more complicated in future.  She also explained the risks of removing it, which mainly came down to there being a statistically insignificant chance of the surgery leaving me blind. 

The decision to have surgery was simple enough but I discussed it with my wife first. I booked my surgery the next day and was scheduled to be operated on in a few weeks time.

Pterygium surgery is performed in a few hours and you don't typically stay in the hospital overnight. I arrived at the medical centre on the day my surgery was booked and checked in at reception. I completed some paperwork and was then collected by a member of staff who took me to a changing room where I changed into some scrubs.  I was then taken to an operating theatre where a doctor and anesthetist asked me some questions and gave me a bit of information on what to expect.

Although not under full anesthetic I was heavily sedated by the anesthetist and I have no recollection of the surgery. The last thing I remember was receiving an injection in my eye which didn't hurt but had the sensation of pressure on my eye.

I woke up a few hours later and the surgery was finished. I had a large eyepatch covering half of my face and I felt very groggy. The drugs they use to sedate you are very strong and it's the reason why they won't perform surgery unless you have arranged for someone to escort you home afterwards. My wife took half a day's leave (as carers leave) so that she could fetch me from surgery.

Here's what my pterygium looked like the day of and before my surgery:

Pterygium surgery in my case involved cutting out the pterygium and then filling the hole left behind with sclera (the white of your eye) taken from elsewhere. In my case that elsewhere was from the white at the top right of my eye under the eyelid. I assume sclera taken from here because this area isn't exposed to the elements and is thus less likely to become infected and it will heal quicker. It's also a good area to take it from because if it leaves scarring it won't matter from an aesthetic perspective since you can't see it.

Post Surgery

The anesthetic wore off in the hours following surgery and I was left in a tremendous amount of pain and discomfort. The anti-inflammatory and pain killers pills I'd been prescribed did little to help ease this. My eye was swollen and closed but I had a tendency to blink a lot which was excruciating. Tears welled up but couldn't drain because of the eyepatch and this just compounded the irritation. As the night wore on it became more and more uncomfortable and I didn't get much sleep that night. It's probably on of the worst experiences of my life.

The next morning I was scheduled to visit my ophthalmologist for a post-op consultation. The eyepatch was removed and some anesthetic eye drops were administered which brought much needed and immediate relief.

This is what my eye looked like the next day after surgery:

I was booked off work for 4 days and told to relax and not do anything strenuous. Whilst bathing was allowed I was advised to keep my eye from direct exposure to water for at least a few days.

I was also prescribed several different eye drops for inflammation, healing and antiseptic purposes, all of which is usual after pterygium surgery.

My pain and discomfort reduced significantly the next day and within the next few days most discomfort was gone.

Post Surgery Complications

A series of weekly and fortnightly follow up appointments were scheduled with my ophthalmologist to monitor my progress. Although in the days immediately following the surgery my eye felt a lot better (although still red and inflamed as expected), I noticed what appeared to be a small hole developing where they'd cut out the pterygium. When they'd removed the pterygium they'd filled the hole left with a piece of sclera from elsewhere using surgical glue to bind it. It appeared and felt to me as if the binding had come undone and this caused me some concern. I took this photo and emailed it to my ophthalmologists explaining my concern. 

I received a call from her advising this wasn't anything to be concerned about. It was merely a gap where they'd removed the pterygium and would take a while to heal. I couldn't quite reconcile this though because I thought the gap was filled with sclera taken from elsewhere and therefore there should be no gap. I never pressed the matter though and put my trust in her medical expertise.

A few days later I had another follow-up appointment and it was reiterated that my eye was healing as expected. She suggested I keep my eye lubricated though as it was possibly drying out. Polygel droplets were prescribed and I was told to apply them as much as needed.

Another week passed and I continued to feel that my eye wasn't healing as it should be - I could feel something wasn't right whenever I blinked and the mirror showed the hole was still there. Here's a photo I took 2 weeks after the surgery:

It was on my next visit to my ophthalmologist that she conceded there was a problem and that it wasn't healing as expected. The surgical glue that was supposed to have sealed the gap where they'd cut out the pterygium had split and new tissue was not growing over as they'd expected.

I was promptly scheduled or a follow up operation to seal the hole, this time using surgical stitching instead of surgical glue. My ophthalmologist was apologetic about my having to go through a 2nd surgery and assured me it wouldn't come apart again.

The second operation was a lot less invasive since no tissue was removed. It was also day surgery but the recovery time didn't take as long as the first surgery. I only needed to book 3 days off work. The process of undergoing this 2nd surgery was the same as the first and I have no recollection of what happened after they administered the anesthetic.

Unlike the first surgery, when the drugs from the 2nd surgery wore off I wasn't in much pain and I didn't have any trouble sleeping that night.

The next day I had a follow up consultation with my ophthalmologist and had my eye patch removed. This is what my eye looked like following the second surgery:

The quality of the above photo is poor but the black mark you see is where the surgical stitches were inserted. These were dissolving stitches which fortunately meant they didn't require removal (I don't think I could have faced surgery again).

I was prescribed more eye drops for healing and inflammation and continued to take anti-inflammatory tablets. In the weeks that followed I had weekly and then fortnightly consultations with my ophthalmologist to monitor the progress of healing and at one point I had 'plugs' inserted into my tear ducts to stop tears from draining out my eye (the idea behind this was to keep my eye lubricated which would reduce inflammation speed up healing).

About 2 months after my second surgery the inflammation in my operated eye was still not reducing at the rate my ophthalmologist wanted so I was given an anti-inflammatory injection directly into my eye. This was performed at her practice and a local anesthetic was administered first so it didn't hurt.

The Conclusion

Over the weeks and months following the initially surgery I had about 2 dozen follow up consultations each lasting about 10 minutes at most, but I had to wait on average 1 hour before I could see the ophthalmologist (because for whatever reason they can't see you at the exact time your appointment was booked). I'd also spend an hour in traffic getting to and from my ophthalmologist. 

Over the months I was told to stop taking certain of the prescribed eye drops and pills until eventually I was told to stop taking all of them (besides Polygel which is prescription free and can be taken however often I want).

Finally on my last visit to my ophthalmologist almost 6 months after my first consultation, I was given the all clear and she was satisfied that my eye had healed sufficiently. 

As I write this its been about 7 months since my surgery and whilst there is no sign of the pterygium returning I am still left with some redness in my eye and it is prone to irritation (not all always but quite often and some days being worse than others).

This is how my eye looks today:

I think I made the right decision electing to have surgery. 

Whilst I still get occasional irritation my eye doesn't get hardly as red as it used to. I also take comfort knowing that it's hopefully not going to cause me any vision problems in future.

That said, I wouldn't want to go through with surgery again. It wasn't a pleasant experience.

It'll be interesting to see if advances in surgical procedures make pterygium surgery less 'mechanical' in future. Prior to having my surgery I'd already heard of chemical removal of pterygium's but it wasn't an option made available to me and it's possible that it's still an experimental procedure. It's worth looking into though if you're considering surgery.

Costs

The direct costs of the surgery, follow up surgery, injections, pre and post op consultations and medication including eye drops and pills, ran into thousands of dollars - probably in the region of around $4,000. Fortunately my private medical covered most of these costs. Had I used public health insurance my costs also would have been covered and it would have been easier for me to claim these costs (under private medical I had to pay for everything up front myself and then submit paperwork to claim reimbursement for all my costs).

The indirect costs are harder to measure and include things like taxi fares too and from my ophthalmologists practice and escort from my second surgery (under sedation and with poor vision in one eye it wasn't safe for me to be driving post surgery and public transport was impractical). These aren't costs I can claim back and they probably ran to around $200.

Another 'cost' was that of time taken off work. Fortunately I have a manager and a company that were very supportive when it came to my needing time off for surgery and the countless follow-up consultations. As flexible and accommodating as they were though, I had to make up the time and catch up on a lot of work, which meant quite a few late nights in the office. All in all I probably lost 2 weeks of productivity because of the surgeries and follow up consultations.

If you read this far then well done and I hope you found something I wrote to be of use or interest. Feel free to get in touch if you have any questions. Once again, I'm not a medical practitioner and cannot offer any medical advice but I'm more than happy to relate my personal experience to you.

Cheers