Wingskin and treatment

The wing membrane or pterygium is a triangular tissue growth of the conjunctiva that grows from the side onto the cornea. Pterygium is basically a benign growth. It has been proven that it frequently occurs in people who work outdoors a lot and are often exposed to direct sunlight. The exact mechanism behind this is unknown.

symptoms

• Dry eyes: Normally, the eyelids moisten the surface by blinking eyelids, similar to car windshield wipers. The wing membrane is slightly elevated and is therefore an obstacle to the distribution of the tear film, which leads to dry eyes.
• Redness: Chronic dry eye causes permanent irritation and redness. The dry surface can result in reduced vision, blurred vision and fog vision.
• Corneal curvature: Pterygium can change the topography, i.e. the natural curvature of the cornea, in such a way that a corneal curvature occurs and this worsens visual acuity.

When is a pterygium surgically removed?

There are various reasons to remove pterygium:

• strong growth trend
• The pterygium causes astigmatism
• The pterygium approaches the pupil and thus the optical axis
• The pterygium is disruptive to laser eye treatment or cataract surgery

The pterygium is also often removed for cosmetic reasons. When people meet and talk to each other, they usually unconsciously look at each other's eyes and mouths. Cosmetic defects in these areas are particularly noticeable and can therefore be very annoying for the person affected.

operation process

The pterygium is carefully removed from the cornea and from the sclera (sclera) using a fine scalpel. In the case of smaller wing skins, the defect on the sclera can be closed with a simple suture. Before closing, the underlying sclera can be treated with medication (mitomycin C solution/MMC 0.02%) to reduce the risk of the pterygium growing again.

In the case of larger pterygia, however, the defect on the sclera is covered with a precisely cut conjunctival transplant. The transplant is taken from another part of the same eye and sutured where the pterygium was removed. This creates a kind of barrier that prevents the wing membrane from growing back. The operation takes about 45-60 minutes and is performed on an outpatient basis under local anesthesia.

Pterygium surgery with fibrin glue

In conventional pterygium surgery, the conjunctival transplant is sutured with threads over the defect. These threads usually dissolve after 1-2 weeks and cause foreign body sensation, scratching and tears. Sometimes individual sutures must be removed before they have dissolved, as interfering thread granulomas form.

If a specially developed fibrin adhesive is used instead of the threads to fix the transplant almost seamlessly, these symptoms can be reduced to a minimum. Healing is faster with this method and the cosmetic result is proven to be better on average.
The additional costs for fibrin adhesive are not part of the KVG (Health Insurance Act) and must therefore be covered by the patient.

The head of the pterygium is often fused with the underlying cornea, which can lead to visible whitish whitening in the area above the iris. These whitenings are usually located in the upper area of the cornea and can be completely or partially removed with a special diamond drill.

Potential risks and complications

Depending on the method of operation, the risk of the wing membrane regressing is 10-20%. It is possible to operate on a wing membrane several times. In very rare cases, leather or cornea may melt, which can be treated with cortisone.

FAQs - common questions

Can the development or progression of pterygium be prevented?

Pterygium may be prevented by reducing or avoiding severe UV exposure to the eyes. Therefore, wearing sunglasses outdoors is definitely recommended. Regular moistening of the eyes with tear substitutes can also be useful.

So can pterygium be treated conservatively without surgery?

To date, there are no drugs that cause pterygium to regress. Surgical removal is therefore the only way to remove the wing membrane. Small pterygias, which repeatedly cause inflammation of the conjunctiva, can be treated experimentally with eye drops containing corticoid.

Is the operation painful?

Thanks to anesthesia, the operation is not painful. Before surgery, the conjunctiva and cornea are made insensitive with anesthetic eye drops and local anesthesia. If desired, the anesthetist will administer anesthetic (analgosedation) via access to the bloodstream.

What should I do after the operation?

After surgery, the eye is usually closed with a bandage so that the eyelid does not rub on the wound due to the constant eyelid closure. During the first follow-up one to two days after the operation, the bandage is removed again.
Burning pain and tears can be expected in the first few days; painkillers help to reduce these symptoms. If the transplant has been sewn in with threads, a feeling of scratching may persist for several weeks after the operation.
In the first few weeks, no water or shampoo should get into the eye and eye rubbing should be avoided at all costs to protect the transplant.
Work can only be resumed after three to 10 days as long as the patient is not exposed to chemicals or dust.

What does the eye look like after surgery?

In the first two weeks, the conjunctiva is usually still reddened and sometimes bloodshot. The eye then calms down and conjunctival swelling persists in the area of the transplant and the removal site. Sometimes it can take several weeks until the eye looks calmer and whiter again.

What are the benefits of fixing the transplant with fibrin glue?

No seams are used:

• Shorter operation time
• Shorter healing time
• Fewer scratches after surgery
• Cosmetically faster and better end result

What are the benefits of diamond drill treatment?

• Better cosmetic result
• Finer and more regular surface in the area of the cornea and therefore a more stable tear film and less feeling of dryness

‍