Pterygium Excision

Anesthesia Implications

Position: Supine, arms free at side, Bed turned 90 degrees
Time: 5-30 min (very short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

Approach – MAC with local anesthesia. Topical local anesthetic drops will be given by the surgeon. The patient is typically awake for the procedure, but 0.5-2mg midazolam may be used if the patient is anxious.

Retrobulbar Block – this will typically be performed by the surgeon. 30-60mg propofol may be administered beforehand to keep the patient comfortable through the process.

Antibiotic – No IV antibiotic required.

Pterygia are growths that begin in the conjunctiva within the palpebral fissure. These grow into the cornea. As a result, refractive changes and obstructions to vision can occur which justify surgical removal. Other treatment methods include topical lubricants like drops or gels to treat symptoms.

Pterygia can be caused by long term exposure to the sun’s UV light, eye irritation from dust or sand, and increasing age.

The surgeon will dissect the pterygia from the cornea and surrounding conjunctiva. If the lesion is larger, he/she will transpose the conjunctiva or use a free graft technique to cover the bare sclera. The surgeon may apply a topical antimetabolite like mitomycin-C to prevent recurrence.

Surgery is indicated if there is opacity in the visual axis, restriction of eye movement, significant intractable irritation, or induced astigmatism that causes impairment.