What is Pinguecula?
Pinguecula is a harmless, common condition affecting the thin layer that covers the white part of the eye, known as the conjunctiva. The term “pinguecula” comes from a Latin word that means fat or grease. A pinguecula can affect both eyes, but sometimes it only affects one. It looks like a small, yellowish lump on the white part of the eye. This condition is usually found in people who spend a lot of time outside, exposing their eyes to wind, dust, or ultraviolet light.
Most of the time, people with a pinguecula might not like the way it looks, but it doesn’t usually cause any serious problems. If it does cause any discomfort, like a feeling that something is in the eye or itching, using artificial tears (eye drops) can help. In rare cases, if a person is really unhappy with how the pinguecula looks, they may consider having it surgically removed.
What Causes Pinguecula?
Pinguecula, a type of growth on the eye, can become more severe due to several risk factors. These include exposure to sunlight or artificial ultraviolet light, eye injuries, wind, dust, sand, spending a lot of time outdoors, and getting older. The condition is seen more often as people age and is commonly found in men, likely due to their jobs exposing them more to sunlight. Almost all people show signs of pinguecula when they’re in their 80s.
People who wear contact lenses also have a higher risk of developing pinguecula. This is especially true for those who wear hard contact lenses rather than soft ones. This could be because the edge of the contact lens may constantly rub against and inflame the surface of the eye, leading to the early onset of pinguecula.
The nasal side, which is the side closer to your nose, is more commonly affected by pinguecula, which might be because this area gets more sun damage due to light reflecting off the side of the nose.
Pinguecula can also be associated with Gaucher disease, a genetic disorder where fatty substances build up in cells and certain organs. In people with this condition, pinguecula appear pigmented (brown) and triangular. Under a microscope, the cells in these lesions look like Gaucher cells, which are large cells filled with fatty substances. Other similar genetic disorders can also lead to pinguecula.
Risk Factors and Frequency for Pinguecula
Pinguecula is a harmless grey or white-yellow growth that can be found on the eye’s surface. It doesn’t favor one sex over the other, meaning it affects males and females equally. There’s also no difference in how often it occurs among different racial groups. Its prevalence varies around the world, with anywhere from 22.5% to 97% of populations having it.
Signs and Symptoms of Pinguecula
A pinguecula is a harmless, raised, gray-white or yellowish bump that appears on the white part of your eye. It is usually found on the part of the eye between your eyelids, either at the 3 o’clock or 9 o’clock position, but most often on the side nearer your nose. Some people think of it as the first step towards developing a pterygium, another type of eye growth, but this is disputed and there is uncertainty whether a pinguecula really changes into a pterygium.
Generally, a pinguecula doesn’t interfere with your vision. It might not cause any symptoms at all, but some people do find them unsightly. If it gets irritated, it’s called pingueculitis. This might happen when blood vessels in the area start releasing chemicals such as histamine, serotonin, bradykinin, and prostaglandins. This leads to symptoms like a burning sensation, itching, and feeling like there is something in their eye. There might be changes to the tear film that covers the eye’s surface, leading to symptoms of dry eye. Sometimes, small hollows called Dellen can appear near the pinguecula. The length of time that tears remain on the eye may also decrease in people with a pinguecula.
Testing for Pinguecula
Pinguecula, a condition that affects the eye, can be diagnosed without any lab tests. Recent advancements in eye imaging, specifically something called “optical coherence tomography-angiography,” is now used to get a clearer view of the front part of the eye. However, it’s been observed that this condition doesn’t bring about significant changes in blood vessel density compared to a normal eye.
In simpler terms, pinguecula doesn’t affect the amount or appearance of blood vessels in your eye, which can sometimes make it harder to identify with this type of imaging. This portion of the eye imaging is very detailed and can show the unique shape and appearance of pinguecula, which look like wedge-shaped masses. These are similar to the patterns seen in another eye condition called pterygium.
Even though these two conditions share similarities, in pinguecula, this wedge-shaped mass does not extend past a specific region of the eye or lift the outer layer of the eye, which is known as the corneal epithelium. There’s also a clearly visible separation between the pinguecula and the underlying eye tissue. The size or “thickness” of the pinguecula can be estimated using this special eye imaging technique.
Treatment Options for Pinguecula
If you have pinguecula, a condition that results in a small, yellowish bump on the white part of the eye, it is advised that you protect your eyes from sun damage, airborne particles, and windy conditions. Sunglasses and wide-brimmed hats can greatly help during the daytime by limiting exposure. Wearing glasses with polycarbonate or high index lenses offers the best protection as they block all types of ultraviolet (UV) light, which can damage the eyes. Transition lenses, which adjust to light changes, provide similar protection. Polarized lenses and certain types of contact lenses can also offer added UV protection.
Most of the time, pinguecula doesn’t require treatment. If you experience dryness or discomfort, over-the-counter eye drops can help. If the condition becomes inflamed, prescribed eye drops containing steroids or non-steroidal anti-inflammatory drugs can be used to ease the symptoms. Cold compresses or ice packs can also offer relief if the pinguecula is inflamed.
Surgery to remove the pinguecula is typically only done for cosmetic purposes or if the pinguecula interferes with your contact lens wear or causes chronic irritation, despite other treatments. The surgery, usually performed under local anesthesia, involves cutting out the pinguecula and closing up the area with a graft from your conjunctiva (the mucous membrane that covers the front of the eye). After surgery, you’ll likely need to use prescribed antibiotic-steroid eye drops for a period of time.
In some cases, a different approach involving an argon laser might be used instead of surgery for cosmetic removal of the pinguecula. This technique involves applying a laser to the area, selectively controlling the amount of tissue removed which can reduce the risk of any potential complications. This method also uses local anesthetics and usually requires you to use prescribed antibiotic-steroid eye drops afterwards.
Both surgical and laser treatments have been found to give similar results in terms of improvements in appearance. In some cases, surgical removal can also provide relief from dry eye symptoms.
What else can Pinguecula be?
When trying to diagnose pinguecula, doctors might need to consider other conditions that could cause similar symptoms. These conditions include:
- Pterygium: This is a condition that gradually worsens and starts to cover the cornea. If it reaches the area over the pupil, it can affect a patient’s ability to see clearly. Even if it doesn’t reach the pupil, it can distort vision by changing the shape of the eye.
- Conjunctival foreign body: This refers to something foreign getting stuck in the membrane that covers the white of the eye. Symptoms include a feeling of something in the eye and watery eyes. Doctors can often see the foreign body with a special lamp for examining the eye, and it can usually be removed with a sterile needle.
- Phlycten: This is a type of small blister or sore that can appear anywhere on the conjunctiva. It glows under a certain type of dye and is caused by an allergic reaction, often to the bacteria that cause tuberculosis.
- Nodular Scleritis: This condition is characterized by severe pain and marked by a distinct lump or nodule. It involves inflammation of the sclera, or white part of the eye.
- Limbal dermoid: This refers to a pale yellow mass typically located in the lower outer corner of the eye. It may involve the conjunctiva and cornea.
- Conjunctival malignant melanoma: This is a rare cancer that arises in the conjunctiva. It appears as a raised, pigmented spot with a blood supply, visible to the naked eye.
- Conjunctival epithelial inclusion cyst: This is a fluid-filled blister under the conjunctiva. It usually doesn’t cause symptoms.
- Ocular surface squamous neoplasia: This is a common eye surface cancer. Patients often complain of eye redness and the feeling of something in their eye. Over time, it can grow towards the outer edge of the cornea, often accompanied by a large blood vessel.
- Conjunctival naevus: This is a harmless pigmented spot on the conjunctiva.
What to expect with Pinguecula
A pinguecula is usually a harmless condition that doesn’t cause any symptoms. Simply put, it’s a benign (non-dangerous) growth. The outlook for those with a pinguecula is generally good. The main issue it presents is related to appearance, as it may change the look of your eye.
Over time, a pinguecula might gradually get bigger or evolve into a pterygium. A pterygium is a similar growth that extends onto the cornea, the clear outer layer at the front of your eye.
Possible Complications When Diagnosed with Pinguecula
Pinguecula is typically symptom-free. Could it be causing symptoms or frequent periods of inflammation (pingueculitis), surgery should be considered as an option. There are a few risks associated with pinguecula removal, which may include the pinguecula growing back and changes in skin color at the removal site.
Possible Side Effects:
- Pinguecula coming back
- Color changes at the removal site
Preventing Pinguecula
If you have been diagnosed with pinguecula, a type of growth on your eye, it’s important to take certain precautions to keep your symptoms from getting worse. It’s crucial to protect your eyes from elements like ultraviolet light, wind, and dust.
One simple way to protect your eyes is by wearing sunglasses and wide-brimmed hats, particularly during daylight hours. These will help shield your eyes from the sun and reduce potential damage. Using a wide-brimmed hat or visor can actually lower the amount of harmful ultraviolet light that reaches your eyes by up to 30%.
