And Pterygium

Pingueculae are raised, localised, yellowish-grey lesions that occur in the bulbar conjunctiva, close to the lim-bus on the nasal or temporal side of the cornea. Pterygia are similar in appearance and also develop in these areas, but involve the peripheral cornea, mostly the nasal side, as well. Pingueculae and pterygia are degenerative lesions causally related to prolonged actinic exposure. The lesions are often bilateral and occur in middle-aged and elderly patients, especially in areas with high levels of sunlight. On histologic examination both lesions are identical. The essential feature is elastotic degeneration of the collagen, resulting in a subepithelial zone of amorphous, basophilic material (Fig. 10.4). This material stains black with the Elastica van Gieson stain (Fig. 10.5). In older lesions calcification can occur. The overlying epithelium may show a wide variety of changes, but most frequently it is thin, atrophic conjunctival epithelium or acanthosis without cellular atypia. In the epithelium an actinic keratosis or even a squamous cell carcinoma may develop [110].

Since pingueculae are not progressive, they are seldom excised. Pterygia are of more clinical importance because of their extension to the cornea.

Fig. 10.3. Conjunctival inclusion cyst: a cystic space is covered with non-keratinising cuboidal epithelium, containing goblet cells

Fig. 10.4. Pinguecula: amorphous, basophilic material in the stroma represents the elastotic degenerated collagen

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