PANCE Blueprint EENT (7%)

Pterygium (ReelDx + Lecture)

VIDEO-CASE-PRESENTATION-REEL-DX

pterygium50-year-old with a growth extending over the cornea (watch video)

Patient will present as → a 65-year-old male Hispanic farmworker who is brought to you by his concerned wife. She reports he has had this "thing" on his left eye for years and refuses to seek care. He denies pain or discharge from the affected eye. Physical exam reveals an elevated, superficial, fleshy, triangular-shaped fibrovascular mass in the inner corner/nasal side of the left eye.

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Pterygium is associated with increased sun exposure and climates where there is wind, sand, and dust.

  • Differentiate from pinguecula: yellow, elevated nodule on nasal side of eye (fat and protein) does not grow.
superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of they eye)

superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of they eye)

This is a clinical diagnosis

  • Look for an elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass

Management is observation in most cases (artificial tears)

  • Only surgically remove when vision is affected
Question 1
The best course of action for a patient with a bothersome inflamed pinguecula (pingueculitis) is
A
antibiotic drops
Hint:
Antibiotic drops have no benefit with pingueculitis.
B
excision
Hint:
Excision is indicated for a pterygium that is threatening vision.
C
Visine drops
Hint:
Visine drops will not do anything, but artificial tears may be beneficial.
D
no treatment
Question 1 Explanation: 
Pinguecula are hyaline, elastic nodules that appear yellow and affect both sides of the cornea but usually more on the nasal side. Pterygium is a fleshy, triangular growth of a pinguecula that involves the cornea. With pingueculitis, no treatment is necessary; a short course of NSAID drops or steroids may help.
Question 2
Pterygium is associated with
A
An increased risk of glaucoma
Hint:
See B for explanation
B
Involvement of the pupillary area, which may require surgical excision if affected
C
Improvement with the use of topical anesthetics
Hint:
In most cases, treatment is supportive with topical vasoconstrictors, saline drops, and protection from sunlight. Surgery is reserved for more severe cases in which vision is compromised.
D
Trauma to the retina
Hint:
See B for explanation
E
Macular degeneration
Hint:
See B for explanation
Question 2 Explanation: 
Pterygium is a fleshy, triangular growth of a pinguecula that involves the cornea. In some cases, it may involve the pupillary area and requires surgical removal. The causes include irritation from UV sunlight, allergens, and excessive drying, sandy, or windy conditions that cause chronic irritation. In most cases, treatment is supportive with topical vasoconstrictors, saline drops, and protection from sunlight. Surgery is reserved for more severe cases in which vision is compromised.
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Corneal ulcer (Prev Lesson)
(Next Lesson) Lacrimal disorders (PEARLS)
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