Pinguecula

Pinguecula is an extremely common, inocuous, usually bilateral and asymptomatic condition.

It is seen as a yellow- white deposit on the conjunctiva adjacent to the limbus (the junction between the cornea and sclera). It is to be distinguished clinically from pterygium, which is a wedge shaped area of fibrosis that appears to grows into the cornea.

Histologically it shows degeneration of the collagen fibres of the conjunctiva stroma with thinning of the overlying epithelium and occasional calcification. Solar actinic exposure of the thin conjunctiva tissue results in fibroblasts producing more elastin fibres, but they are more twisted than normal and may lead to the degradation of the collagen fibres. Alternatively, it has been stated that the sub-epithelial collagen fibres undergo degradation and assume the qualities of elastic tissue while fragmenting and twisting in a different configuration from their normal state.

Pingueculae are found more often on the nasal side of the conjunctiva. While most pingueculae are found over the age of 40, they are not uncommon in 20 and 30 years old adults who spend significant time in the sun.

Pingueculae have abnormal tear surfacing over their surface. The tear ferning test shows abnormalities of the mucous component of the tear film. The tear ferning test has a high predictive value of hydrophilic soft contact lens success. Contact lens intolerance can also result from the elevation of the peripheral edge of the contact lens if it positions on top of the pinguecula.

Prognosis and treatment

They may enlarge slowly but is a benign condition requiring no treatment. Artificial tears are occasionally used if there is discomfort or to reduce minor injection of blood vessels. If cosmesis is a concern surgical excision is sometimes done. Occasionally a pinguecula may become inflamed, a condition referred to as pingueculitis. The cause of pingueculitis is unknown but there are no known infectious agents associated with its manifestation. If an inflamed pinguecula is causing discomfort or cosmetic concerns it may be treated with anti-inflammatory prescriptions.

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More Video’s on Pinguecula and the difference to Pterygium