Pterygium and its surgery
A pterygium is a fleshy, wing-shaped growth from the conjunctiva (the clear skin over the white of the eye) that crosses onto the cornea. Ultraviolet light appears to be a major cause. A pterygium can blur vision, limit eye movement, and cause irritation, a gritty feeling, and dryness. In some people it grows far enough to block the center of vision.[1]
Surgery is the only effective treatment, but pterygia often come back. Simply cutting it out and leaving the white of the eye bare has a reported recurrence risk of upwards of 80%. Covering the area with a graft lowers that risk. In a conjunctival autograft, the surgeon takes a piece of healthy conjunctiva, with some tissue from the edge of the cornea, from elsewhere on your eye. The alternative is a graft of donor amniotic membrane. A Cochrane review of 20 trials found a lower risk of recurrence at six months with a conjunctival autograft.[1]
Older techniques matter here. Beta radiation was once applied after excision to stop pterygia returning. In a 1980 study that examined 63 treated eyes 3 to 20 years later, 51 had ulceration of the sclera (the white of the eye), and four people developed a serious infection inside the eye.[2] A 2013 review describes a woman who developed severe scleral inflammation 23 years after pterygium surgery with beta radiation, and lists pterygium surgery among the operations most often followed by infectious scleral necrosis (tissue breakdown).[3]
Why the question matters for scleral lenses
A scleral lens is a large rigid gas-permeable lens. It rests on the sclera, over the conjunctiva, and arches over the whole cornea without touching it. Its landing zone sits just outside the edge of the cornea. That is exactly where a pterygium grows and where its surgery is done.
Most people who ask about this aren’t seeking a scleral lens for the pterygium itself. They need one for something else, such as keratoconus or a scarred cornea, and want to know whether the old surgical area will cause a problem. A 2023 review does list pterygium among the conditions scleral lenses have been used to manage, but it doesn’t describe outcomes.[4]
Three things about a surgical site can affect a fit:
- Raised tissue. A graft, scar, or recurrence can stand up from the surface. Where a lens edge presses on a raised spot, it can become inflamed. This has been reported with pingueculae, raised spots on the white of the eye that are similar to pterygia but don’t cross onto the cornea: in a study of 157 keratoconus eyes wearing scleral lenses, 1.3% developed an inflamed pinguecula.[7] Reviews describe pinguecula irritation as a known but infrequently reported fitting problem.[5][6]
- Thin or fragile sclera. After radiation or other adjuncts, the white of the eye can be thinned or ulcerated, as described above. Resting a lens on that tissue is a question for your eye doctor, not just your fitter.
- An uneven landing surface. Standard scleral lenses have a regular landing zone. Eyes with uneven surfaces can be fitted with designs that vary around the edge, or with lenses made from a mold or scan of the eye.
What the research shows
We found no studies of scleral lenses after pterygium surgery. The evidence below is indirect. It shows that fitters can design around uneven landing areas, not that doing so works well over a pterygium site.
Custom landing zones exist. In a study of 70 eyes at three specialty practices fitted with impression-based lenses (made from a mold of the eye), 39% of patients had had at least one surgery on the front of the eye, and 29 had failed standard scleral lenses. Ideal alignment of the landing zone was achieved in 74% of fits, and fitting took an average of 4 visits.[8] A case report describes a lens with a different curve in each quarter of its edge, used after an injury left the edge of the cornea and the sclera irregular.[9]
The nearest comparison is glaucoma surgery. Some glaucoma operations leave a raised bleb on the white of the eye. In a 15-year review of 39 such eyes at one academic center, 51% wore contact lenses successfully for at least a year. Rigid corneal lenses were more common among those who succeeded, and scleral lenses not made from an impression were more common among those who didn’t.[10] A bleb is not a pterygium graft, so treat this only as a sign that surgical sites on the white of the eye can complicate lens wear.
Other options, compared
| Option | What it does | Typically suited to |
|---|---|---|
| Glasses or soft lenses | Correct regular prescription | Blur without much corneal irregularity |
| Corneal rigid gas-permeable lenses | Sit on the cornea, inside the surgical area | Irregular corneas, when the lens centers well |
| Hybrid lenses | Rigid center with a soft skirt | People who can’t tolerate a rigid corneal lens |
| Standard scleral lenses | Land on the white of the eye and vault the cornea | Irregular corneas when the surgical area is flat and healthy |
| Impression-based or quadrant-specific scleral lenses | Match the landing zone to the shape of your eye | Uneven landing areas, or failure of standard scleral lenses |
| Repeat pterygium surgery | Removes a recurrence | A pterygium that has grown back |
Questions to ask a scleral lens fitter
- Will the edge of the lens rest on my surgical area, and how will you check?
- Is the area raised, thin, or inflamed? Should my surgeon look at it first?
- I had radiation (or another treatment) with my surgery. Does that change anything?
- Would a lens made from a scan or mold of my eye fit better?
- What should I do if that area gets red or sore while I wear the lens?
- How many visits do you expect, and what do the fees cover?
Common questions
Can I wear a scleral lens after pterygium surgery?
Often a fitter can find a way, but there's no research to give you odds. The lens lands on the white of the eye, which may include your surgical area. Your fitter will look at how raised, thin, or inflamed that area is and design the lens around it.
How long after pterygium surgery should I wait before a fitting?
We found no published guidance specific to scleral lenses. The surgical site needs to heal, and trials of pterygium surgery check for recurrence at three and six months. Ask your surgeon when the area is stable enough for a lens to rest on or near it.
Could a scleral lens make my pterygium come back?
We found no research on this either way. Irritation where a lens rests on a raised spot has been reported with pingueculae, which are similar growths that don't cross onto the cornea. If the surgical area gets red or sore with lens wear, tell your fitter.
I had pterygium surgery decades ago with radiation. Does that matter?
Yes, tell your fitter and eye doctor. Beta radiation was once used to prevent pterygia coming back, and long-term follow-up found thinning and ulceration of the white of the eye in many treated eyes. Your eye doctor should examine that area before a lens rests on it.