Pinguecula - An overview

1. PINGUECULA
Indra PSharma
Optometrist, Bhutan

2. Objective
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 To have a better understanding about
pinguecula with regard to its
pathophysiology, clinical manifestation,
management and prevention.

3. Contents
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1. Overview of pinguecula
2. Pathophysiology
3. Etiology
4. Clinical features and differential diagnosis
5. Treatment
6. Possible complication
7. Culprit in CL practice
8. Prevention
9. Conclusion
10. References

4. Introduction
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 Common degenerative condition of the
conjunctiva.
 Yellowish white patch on the bulbar
conjunctiva.
 Derived from pinguis (meaning fat )
 Considered a precursor of pterygium

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Typical pinguecula

6. Characteristics
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 Presents as yellowish white patch near limbus.
 Usually affects the nasal side first and then the
temporal side.
 When conjunctiva is congested, it stands out
as an avascular prominence.
 Calcification occurs occasionally.
 Remain stationary or may enlarge gradually
over long periods of time.

7. ICDCode
 International Classification of Disease (ICD)
code for Pinguecula
 ICD-10 : H11.1
 ICD-9 : 372.51
Sharma IP

8. Epidemiology
 Male: female= 2:1
 Most common over the age of 40
 But may occur in 20 and 30 years old adults
who spend significant time in the sun.
 May have an increased prevalence
in Gaucher's disease.
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9. Pathology
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 Elastotic degenerationo f collagen fibres of the
substantia propria of conjunctiva
 Plus deposition of amorphous hyaline material
in the substance of conjunctiva.
 Histologically it shows degeneration of the
collagen fibers of the conjunctiva stroma with
thinning of the overlying epithelium and
occasional calcification

10. Etiology
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 Etiologyis not knownexactly.

11. Contd..
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 UV radiation is
thought to be main
trigger factor.
 Therefore, the
incidence is much
higher in equatorial
countries

12. Contd..
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Incidence is much higher in
equatorial countries
More in those who
are usually outdoor

13. Contd...
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 Figure : The UV radiation affects the temporal
area and travels through the cornea to the
nasal area, where the UV power increases up
to 20 times more.

14. Contd...
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 Insults such as
welding.
 Dust and wind.

15. Clinical features
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Symptoms
 Usually asymptomatic
 Ocular irritation and
discomfort
 Aesthetic concerns
 Recurrent inflammation

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Signs
 Appearance of yellow-white, amorphous
subepithelial deposits epithelium.
 Appear adjacent to the limbus in the
interpalpebral zone, more often nasally.
 Conjunctiva overlying a pinguecula may be
normal, thick, or thin.

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18. Differential diagnosis
 Squamous Cell Carcinoma
 Bitots spot
 Phlectenule
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19. Examination and diagnosis
 Obvious clinical diagnosis
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No
treatment
required
Treatment

21. Contd..
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 Lubricant to alleviate ocularirritation

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Excision indicated when pinguecula
 Cause cosmetic problems
 become chronically
inflamed(pingueculitis)
 interfere with successful
contact lens wear.
Contd..

23. Contd...
 In a study (July 2013) removal of pingueculae
with a laser vs. traditional surgical excision
was compared.
 Researchers found
 Eyes treated with argon laser
photocoagulation- (90.5 %) complete removal
of pingueculae
 Eyes treated with traditional surgical excision -
(63.9 %) complete removal
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Weaktopical steroids
 Judicious use of weak topical steroids may be
considered in patients with chronic
inflammation.
Eg. Gtt. Fluorometholone tds reducing over 3
weeks.
 But they are strongly discouraged as a chronic
therapy due to their side effects
Contd..

25. Complication
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 Rarecomplication
 inflammation,
intraepithelial abscess
formation
 rarely conversion into
pterygium

26. Prognosis
 Visual and cosmetic prognosis is good.
 Vision is not affected.
 No systemic and genetic association noted.
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27. The culprit in CL practise
 A common scleral obstrucle in CL practise.
 Small pinguecula doesnt cause problem.
 However larger can cause decentration of
contact lens.
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28. Contd
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 The firm nature of scleral GPs can cause
patients significant irritation if the lens edge
bumps into the pinguecula, or their rigidness
will prevent an acceptable fit if an elevated
pinguecula lies beneath the haptic.
 In such cases, we consider a corneal GP, soft
specialty design, or hybrid design.
Alternatively, a notch can be beveled out of a
scleral lens, which will allow it to bypass the
pinguecula.

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 Aviod eye
irritants
Prevention

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 Good quality
Sunglasses
 Hats and caps
Contd...

31. Conclusion
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 Pingucula is a common disease.
 Lubrication is the mainstray treatment.
 Most cases can be managed by optometrist.
 Some special attention may be required in
contact lens practise.

32. Reference
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Books andjournals
 American Academy of Ophthalmology, External DiseaseandCornea
,Section 8 (2011-2012), 12: 331-332
 Kamel S. Thepterygium: its etiologyandtreatment. Am J Ophthalmology,
1954;152(5):733-8
 Kanski Jack J, Clinical Ophthalmology- Asystemic approach, 6th Ed,
Butterworth Heineman Elsevier. 8: 242
 Jackson Timothy L, MoorfieldMannual of Ophthalmology, Mosby Elsevier,
4:137
Websites:
 http://pterigion.net/2012/09/03/pterygium-what-is-it-how-is-it-treated/
retrieved on 1/2/2015
 http://www.nytimes.com/health/guides/disease/pinguecula/overview.html
retrieved on 1/2/2015
 http://www.clspectrum.com/articleviewer.aspx?articleID=107286 retrieved
on 1/2/2105
 http://en.wikipedia.org/wiki/Pinguecula retrieved on 1/2/2105

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34. Questions?
 What are the causes of pinguecula?
 Why is the prevelance of pinguecula more in
male?
 What is the optometric management of
pinguecula?
 What are the indication for pinguecula
excision?
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35. Tashi Delek
Sharma IP