Abstract
This paper reviews the histological and epidemiological characteristics of pterygium which suggest that chronic exposure to ultraviolet radiation plays an important role in the pathogenesis of this disorder. However, there is conflicting evidence indicating that chronic inflammation from other causes can induce the disease. The results of two epidemiological surveys undertaken in Southern Africa show that pterygium is not closely linked to other chronic actinic disorders such as Pinguecula and climatic droplet keratopathy. Pterygia differ from these disorders by their vascularity which is probably induced by chronic inflammation. On histological examination, we found that excised pterygia contained a lymphocytic infiltration consisting predominantly of T cells. In the pathogenesis of pterygium we believe that chronic irritation (from whatever cause) produces a chronic inflammatory cell infiltration with resultant inflammatory oedema, attempt at repair and cell induced angiogenesis. These processes, together with actinic damage, are responsible for the fibrovascular reaction so characteristic of a growing pterygium.
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References
Duke-Elder S : Textbook of ophthalmology. St Louis: Mosby, 1954, 7: 570–86.
Spencer WH and Zimmerman LE : Conjunctiva. In: Spencer WH, ed. Ophthalmic pathology: an atlas and textbook, Vol 1. Philadelphia: WB Saunders, 1985, 109–228.
Cogan DG, Kubara T, Howard J : The nonelastic nature of pingueculas. Arch Ophthalmol 1959, 61: 388–9.
Hogan MJ and Alvarado J : Pterygium and pinguecula: Electron microscopic study. Arch Ophthalmol 1967, 78: 174–86.
Austin P, Jakobiec FA, Iwamoto T : Elastodysplasia and elastodystrophy as the pathologic bases of ocular pterygia and pinguecula. Ophthalmology 1983, 90: 96–109.
Ledoux-corbusier M and Danis P : Pinguecula and actinic elastosis. J Cut Pathol 1979, 6: 404–13.
Hilgers JHC : Pterygium: its incidence, heredity and etiology. Am J Ophthalmol 1960, 50: 635–44.
Cameron ME : Pterygium throughout the world. Springfield, Ill: Charles C. Thomas, 1965.
Taylor HR : Aetiology of climatic droplet kera-topathy and pterygium. Br J Ophthalmol 1980, 64: 154–63.
Darrell RW and Bachrach CA : Pterygium among veterans. Arch Ophthalmol 1963, 70: 158–69.
Moran DJ and Hollows FC : Pterygium and ultraviolet radiation: a positive correlation. Br J Ophthalmol 1984, 68: 343–6.
Taylor HR : Climatic droplet keratopathy and pterygium. Aust J Ophthalmol 1981, 9: 199–206.
Fuchs E : Ueber das Pterygium. Albrecht von Graefes Arch Ophthalmol 1892, 38: 1–90.
Kamel S : The pterygium: its etiology and treatment. Am J Ophthalmol 1954, 38: 682–8.
Kerkenezov N : A pterygium survey of the far north coast of New South Wales. Trans Ophthalmol Soc Aust 1956, 16: 110–19.
Hubner W : Der Lidspaltenfleck. Arch Augenheilkd 1898, 36: 70–91.
Talbot G : Pterygium. Trans Ophthalmol Soc NZ 1948, 2: 42–5.
Norm M : Spheroid degeneration, keratopathy, pinguecula, and pterygium in Japan (Kyoto). Acta Ophthalmol 1984, 62: 54–60.
Karai I and Horiguchi S : Pterygium in welders. Br J Ophthalmol 1984, 68: 347–9.
Ansari MW, Rahi AHS, Shukla BR : Pseudoelastic nature of pterygium. Br J Ophthalmol 1970, 54: 473–6.
Detels R and Dhir SP : Pterygium: a geographical study. Arch Ophthalmol 1967, 78: 485–91.
Freedman A : Labrador keratopathy. Arch Ophthalmol 1965, 74: 198–202.
Forsius H : 1972, 1974, 1978. Cited by: Norm M. Spheroid degeneration, keratopathy, pinguecula, and pterygium in Japan (Kyoto). Acta Ophthalmol 1984, 62: 54–60.
Hill JC : The prevalence of corneal disease in the coloured community of a Karoo town. S Afr Med J 1985, 67: 723–7.
Hill JC, Maske R, Van der Walt S, Coetzer P : Corneal disease in rural Transkei. S Afr Med J 1989 (In Press).
Johnson GJ and Overall M : Histology of spheroidal degeneration of the cornea in Labrador. Br J Ophthalmol 1978, 62: 53–61.
Maske R, Hill JC, Van der Walt S : Smoke related pingueculae in rural Transkei. (Submitted for publication.)
Ashton N and Cook C : Mechanisms of corneal vas-cularisation. Br J Ophthalmol 1953, 37: 193–209.
Campbell FW and Michaelson IC : Blood-vessel formation in the cornea. Br J Ophthalmol 1949, 33: 248–55.
Fromer CH and Klintworth GK : An evaluation of the role of leukocytes in the pathogenesis of experimentally induced corneal vascularisation. II Studies on the effect of leukocyticelimination on corneal vascularisation. Am J Pathol 1975, 81: 531–44.
Fromer CH and Klintworth GK : An evaluation of the role of leukocytes in the pathogenesis of experimentally induced corneal vascularisation. III Studies related to the vasoproliferative capability of polymorphonuclear leukocytes and lymphocytes. Am J Pathol 1976, 82: 157–70.
Klintworth GK : The cornea: structure and macro-molecules in health and disease. Am J Pathol 1977, 89: 719–808.
Cogan DG : Vascularisation of the cornea. Its experimental induction and a new theory of its pathogenesis. Arch Ophthalmol 1949, 41: 406–16.
Wong WW : A hypothesis on the pathogenesis of pterygiums. Ann Ophthalmol 1978, 10: 303–8.
Pinkerton OD, Hokama Y, Shigemura LA : Immunologic basis for the pathogenesis of pterygium. Am J Ophthalmol 1984, 98: 225–8.
Nishioka K and Katayama I : Angiogenic activity in culture supernatant of antigen-stimulated lymph node cells. J Pathol 1978, 126: 63–9.
Auerbach R and Sidky YA : Nature of the stimulus leading to lymphocyte-induced angiogenesis. J Immunol 1979, 123: 751–4.
Ben Ezra D : Neovasculogenesis. Triggering factors and possible mechanisms. Surv Ophthalmol 1979, 24: 167–76.
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Hill, J., Maske, R. Pathogenesis of pterygium. Eye 3, 218–226 (1989). https://doi.org/10.1038/eye.1989.31
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DOI: https://doi.org/10.1038/eye.1989.31