A 50-year-old farmer presents with a painless, yellowish subconjunctival fibrovascular lesion encroaching from the nasal limbus onto the cornea, crossing the 4 mm mark from the limbus toward the pupil axis. What is the most appropriate management?

• A Topical lubricant eye drops and reassurance; no intervention needed
• B Surgical excision with bare sclera technique
• C Topical 5-fluorouracil drops for 6 weeks
• D Surgical excision with conjunctival autograft and adjunctive mitomycin-C to reduce recurrence ✓

Explanation

A pterygium encroaching > 3-4 mm onto the cornea (approaching the visual axis), causing astigmatism or threatening visual axis, is an indication for surgical removal. The recurrence rate after bare sclera excision alone is very high (30-80%). The current gold standard is conjunctival autograft (CAG) harvested from the superior bulbar conjunctiva placed over the bare sclera following excision, with or without adjunctive intraoperative mitomycin-C, which reduces recurrence to < 5%. Topical 5-FU is not standard treatment.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.