Definition

Pinguecula is a benign growth of tissue on the conjunctiva, the thin layer that covers and protects the sclera, or the white part of the eyeball. This growth typically does not extend to the cornea, the clear front surface of the eye. The term "pinguecula" is derived from the Latin word "pinguis," meaning "fat." Pinguecula are generally slightly elevated and yellowish-white in color. The incidence of pinguecula varies widely by region, ranging from 22.5% to 97%.

Causes

Pinguecula is caused by irritation of the conjunctiva. This irritation can result from exposure to wind, dust, and ultraviolet (UV) light. It commonly appears on the part of the eye closest to the nose, as this area receives more light exposure while the nasal shadow protects the outer part of the eye. Irritation inhibits the digestion of a protein called elastin by enzymes, leading to its accumulation. Additionally, irritation decreases the antioxidant levels in the eyes, preventing the neutralization of toxic substances.

Risk Factor

The primary risk factor for pinguecula is extensive outdoor activity, which increases exposure to UV light, wind, and dust. Higher sun exposure in tropical regions, such as Indonesia, results in a higher incidence of pinguecula. A history of eye trauma also contributes to the risk. The incidence of pinguecula increases with age and is more prevalent in men, likely due to greater outdoor work and sun exposure. Nearly all individuals in their 80s show some signs of pinguecula. Wearing contact lenses can also elevate the risk due to friction and inflammation of the conjunctiva, causing pinguecula to develop at a younger age. Additional risk factors include smoking and diabetes mellitus.

Symptoms

The primary symptom of pinguecula is a yellowish-white lump on the sclera, typically near the area towards the nose, and can appear in one or both eyes. While pinguecula does not impair vision, it may cause discomfort for contact lens wearers. Generally, pinguecula is asymptomatic and primarily affects appearance. It does not interfere with vision, but if you are a contact lens wearer, you may experience some difficulty in fitting the contact lenses. 

However, inflammation of the pinguecula, known as pingueculitis, can cause symptoms such as red, watery, and painful eyes, along with a sensation of a foreign body in the eye. This inflammation can disrupt tear flow, making the eyes more prone to dryness.

Diagnosis

A doctor can diagnose pinguecula with the help of a visual acuity test to differentiate it from pterygium, which is a similar growth that can extend into the cornea. A slit lamp examination provides a clearer view of the pinguecula, which is typically a yellowish-white tissue and may contain blood vessels. This examination can also detect minor corneal damage or thinning. Optical coherence tomography (OCT) can be used to measure the thickness of the pinguecula. 

Laboratory tests are unnecessary for diagnosis. Although pinguecula tissue can be removed and examined under a microscope for diagnostic purposes, this procedure is not required for diagnosis.

Management

Pinguecula can often be managed on their own. Things that should be paid attention to for patients include:

1. When engaging in outdoor activities, protect your eyes and head. Sunglasses shield the eyes from ultraviolet rays, wind, and dust, while a wide-brimmed hat provides additional protection. Eyes and head protection is needed from UV rays, wind, and dust exposure.
2. To alleviate itchiness and dryness, over-the-counter artificial tear drops can be used. These drops should be used up to six times daily, one drop per eye, to maintain eye moisture and shield the eyes from irritants that could exacerbate the condition.
3. For red and inflamed eyes, apply a cold compress for 10-15 minutes to reduce eye pain and inflammation. Cold compresses can help relieve pain due to inflammation of the pinguecula.

In addition to these home remedies, consult with a doctor to determine if surgical intervention is necessary. Surgery may be considered if the pinguecula significantly affects appearance, the eyes frequently become inflamed or chronically inflamed, or the condition interferes with contact lens use. Surgical options include laser removal or excision of the pinguecula.

Complications

Pinguecula can develop slowly, even though it does not impair vision. However, frequent inflammation, combined with dry eyes and minor corneal wounds, can disrupt the healing process. This may lead to the development of pterygium, a pink membrane on the sclera that can potentially affect vision and require specialized medical treatment. 

Surgical removal of pinguecula can also result in complications, such as recurrence or changes in the color of the operated area of the eyeball.

Prevention

Preventive actions include wearing sunglasses and hats during outdoor activities to protect against UV rays, dust, wind, and sand, which can cause eye injuries leading to pinguecula. In dry and dusty environments, such eye protective measures are particularly important. Regular use of artificial tear drops can help maintain eye moisture and protect the eyes from dryness. 

Additionally, smokers should consider quitting, as smoking increases the risk of pinguecula. For individuals with diabetes mellitus, managing blood sugar levels through medication, diet, and physical activity can also help prevent this condition.

When to See a Doctor?

Medical consultation is recommended if symptoms of dry eyes such as redness, excessive tearing, itchiness, and foreign body sensation occur, as these could indicate an inflamed pinguecula. Immediate medical attention is necessary if these symptoms are accompanied by blurry vision, as this may signal the growth of pterygium into the cornea or other serious conditions like corneal wounds or foreign objects attaching to the cornea.

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