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Optometric Management of the Pterygium View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CommonKnowledge Pacific University CommonKnowledge College of Optometry Theses, Dissertations and Capstone Projects 2-5-1982 Optometric management of the pterygium Scott R. Walt Pacific University Steven Meyers Pacific University Recommended Citation Walt, Scott R. and Meyers, Steven, "Optometric management of the pterygium" (1982). College of Optometry. 650. https://commons.pacificu.edu/opt/650 This Thesis is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at CommonKnowledge. It has been accepted for inclusion in College of Optometry by an authorized administrator of CommonKnowledge. For more information, please contact [email protected]. Optometric management of the pterygium Abstract Optometric management of the pterygium Degree Type Thesis Degree Name Master of Science in Vision Science Committee Chair Subject Categories Optometry This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/650 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license.] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:[email protected] Tr ' .:> - I Of' T, tJ ~ l. s R OPI'OMETRIC MANAGEMENT OF THE PI'ERYGIUM by , Scott R. / Walt Steven Meyers~ • rv-. -- e)..tr _.h,J {r,:L~ .. [ l / February 5, 1982 OPI'OMETRIC MANAGE1'1ENT OF THE PI'ERYGIUM Researched and reported by Scott R. Walt and Steven Meyers Fterygiums have been recognized and described for approximately 3000 years. 1 Although during this time a great deal of information has been acquired concerning the characteristics of pterygiums, there are still many questions about them that remain unanswered. Irt this paper we will discuss various aspects of pterygiums, the questions that are still unan- swered, and the role of the optometrist in caring for them. Suruta, an Egyptian surgeon in 1000 B. C. described the occura.nce of 2 pterygiums as common in his time and he also described one of the oldest surgical procedures of them on record. Suruta believed pterygiums were due to a nutritional deficiency.J Aetius, a physician in Constantinople, described a surgical procedure for the removal of a pterygium in the fifth centuary B.c.3 Pterygiums were also described by Hippocrates in 460 B.C. and Galen in 131 A.D. As information has been gathered, a con- sistency in conditions has been noted. Personal observations of both optometrists and opthalmologists have shown that pterygiums are very frequently seen in warm, dry, windy and dusty regions but less frequently in still, humid and warm regions of the south. People, such as ranchers and farmers, whose occupation causes them to be exposed repeatedly for long periods of time to these f:l:rst cond.i-- tions &re':i5een to have a higher incidence of pterygiums. A study of saw­ mill workers·, in particular, brought out some interesting information. A Page 2 25%_ &ge-adjusted prevalence rate was found in sawmill workers compared to a ?%'rate in the control group and the data indicated that the chance of developing a pterygium increased with the length of employment at the saw­ mill.3 Geographically speaking, pterygiums occur at an incidence of less than 1% in the population of peoples between the poles and 40° latitude. l"10re specifically, the so-called "pterygium belt" has been defined as that 0 • 4 area from 37° north latitude to 37 south latitude, This describes a strip of area which encircles the earth and is symmetrical with respect to the equator. This, of course, fits in well with the previously listed warm, dry, windy and dusty conditions. In order to obtain more information concerning the characteristics of those people with pterygiums, studies have· been conducted with specific people populations. For example, the Navajo Indians who live in north- eastern Arizona have been found to have a high incidence of pterygiums. An inter~sting factor that goes along with this occurrance is that this area has a gr~ater ~~ount of ultraviolet light than in any other location in the United States.5 Eskimos have been found to have what would appear to be a surprisingly high rate of pterygiums considering that the previ- ously listed condition of a warm climate is for the most part not ful- filled. However, multiple r eflections from the snow are thought possibly to play an imprtant part in this, One source states the rate of incidence in this population to be 9%. 3 A study completed in Newfoundland reports that men over the age of forty have a 33% occurrence rate of pterygiums. j Page 3 The occupations of those with pterygiums were primarily woodsmen and fish- ermen. A study was also completed in Israel which presents some statistics that tend to be difficult to explain. The most prominent fact that stands out concerns pterygium incidence in relation to occupation. Being an ag- ricultural country, we would typically expect a significantly higher in- cidence of pterygiums in those people working outdoors. However, it was found that those people who work indoors had 49% of the pterygiums and ' 6 outdoor workers had only 51%. This slight difference is in no way sig- nificant. Since the factors that apparently correlate with pterygium occurrence are only largely in efflct out of doors, there appears to be no obvious explanation for the findings of this study. A possible explan- ation for this discrepency is that the work hours are from very early morning until noon, similar to field workers in the United States. This schedule, therefore, allows workers to avoid harsh midday conditions which lead to pterygium development. The physical location of pterygiums has also been observed in stud- ies. One such study has found that 91% of the people with pterygiums had them on the medial side and that 25% of the cases were bilateral.? The study in Israel, previously mentioned, found only four people out of 460 (0.87%) had exclusively temporal pterygiums. In addition, a pterygium was not found which extended beyond the center of the cornea.6 An inter- esting and unique sidelight is that a statistically significant number (to the .002 level) had left sided prevelance. Another study, however, Page 4 found a higher rate (2.4%) of temporal pterygiums and no difference in ' 8 occurrence between the right and left eyes. A finding widely agreed tipon was that a large percentage of temporal pterygiums seen are found in conjunction with a nasal pterygium. Another factor widely agreed upon is that there is no significant difference in the rate of pterygium occurrence in males and females. Only one study was specific enough to mention that 52% of the cases were female, which was not significant.? The average age of those studied who had pterygiums was 44. Ftery- giums are rarely seen in people under twenty years of age, with an occur­ rence of only 0.14% in children under sixteen.6 The highest prevalancy = ~ rate, on the other hand, occurs at age fifty. 9 A decline can be observed in occurrence from then on, especially after age 70. It appears from longitudinal observations that pterygiums regress with senescence. How- ever, despite the facts which have been collected concerning age, no sig- nificant age~incidence relationship can be found. The exceptions to this are the extremes as in the very young or very old person. Studies which have been conducted within families have found pteryg- iums to be carried as a dominant trait with variable penetrance. The in- heri ted characteristics have been described as--varying sensi ti vi ty to ultraviotet light, prominence of the eye from the orbit causing greater exposure (as seen in Polynesians), variation in the amount of lacrimal secretion and a variation in the blink rate.9 One study specifically 10 describes 19 year old twins. It was believed that few, if any, environ- Page5 mental factors had a significant role in the developement of their ptery- · gium:s at this age. It was observed that the formation and developement of the pterygiums were similar. Careful scrutinizing of the family tree in this case suggested autosomal dominance with incomplete penetrance, Another study was done on a specific population of people according to their refractive status. Myopes living at the equator where conditions were sunny, windy and 50% humidity were found to have an incidence of only 6.2%. 11 It is believed that the glasses worn by these people acted as a protective barrier for the eyes, thus shielding them from the harsh envi- ronmental factors. This possibility will be discussed to a greater extent later in the paper, Pingueculas are considered by some authorities to be a P-recursor to 12 pterygiums, so, for this reason, we will take .a brief look at them, When observed through the slit lamp, pingueculas are seen as avascu- lar elevations of elastic tissue which are surrounded by conjunctival blood vessels of normal size.
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