Pterygium (Nakhuna) Treatment in Palamu
Expert diagnosis and surgical management of pterygium by Dr. Dibya Prabha, MS Ophthalmology, FICO at Palamu Neuro & Eye Care, Palamu.
What is Pterygium (Nakhuna)?
A pterygium (often called 'Nakhuna' locally) is a fleshy, triangular growth of pink conjunctival tissue that extends from the white of the eye onto the clear cornea. Dr. Dibya Prabha offers both medical management and advanced surgical removal for pterygia.
Symptoms of Pterygium (Nakhuna)
- •A visible, raised pink or red fleshy growth on the eye
- •A gritty, burning, or scratchy sensation
- •Persistent eye redness and inflammation
Clinical Observations at Palamu Neuro & Eye Care
Dr. Dibya Prabha at Palamu Neuro & Eye Care sees a disproportionately high burden of advanced pterygium in Jharkhand — particularly in farmers and daily-wage labourers who have never worn sunglasses and were unaware that the 'nakhuna' growing over their eye was treatable. Many patients present only when the pterygium has already crossed the visual axis, which limits the quality of post-operative visual recovery.
Standard medical literature states:
Standard ophthalmology texts describe pterygium as a benign fibrovascular proliferation of conjunctival tissue onto the cornea, linked to UV exposure. Surgery is indicated for visual threat, significant symptoms, or cosmetic concern.
We counsel patients in Hindi and regional dialects that 'aankh par chadha ye maans jitna jaldi nikalwayein, utna behtar hai — dekhne ki roshni bach jaati hai' (the earlier this fleshy growth is removed, the better — your eyesight can be saved). We strongly advise post-operative sunglass use and have started keeping affordable UV-protective sunglasses at the clinic for our surgical patients.
— Dr. Dibya Prabha
Causes & Risk Factors
- •Prolonged, lifetime exposure to ultraviolet (UV) radiation from the sun
- •Chronic irritation from dry, dusty, and windy environments
- •Lack of protective eyewear during outdoor work
Diagnostic Tests
Slit-Lamp Biomicroscopy
The primary diagnostic tool for pterygium. Dr. Dibya Prabha uses slit-lamp examination to assess the size, vascularity, and extent of corneal encroachment, measure the distance from the limbus to the head of the pterygium, evaluate the degree of conjunctival inflammation, and rule out other ocular surface lesions such as pinguecula, conjunctival intraepithelial neoplasia, or squamous cell carcinoma. The presence of Stocker's line — an iron deposition line in the corneal epithelium just ahead of the pterygium head — indicates chronicity and stability.
Corneal Topography
Computerised corneal topography provides a detailed map of the corneal surface curvature. Dr. Dibya Prabha uses topography to quantify the degree of corneal astigmatism induced by the pterygium, which is often greater than what manifest refraction alone suggests. Topographic evidence of progressive astigmatism is an important indication for surgical intervention. Post-operative topography objectively documents the reduction in corneal irregularity achieved by surgery.
Anterior Segment Photography
Serial high-resolution anterior segment photographs are taken at each visit at Palamu Neuro & Eye Care to objectively document pterygium size, vascularity, and progression over time. These images are invaluable for monitoring growth, counselling patients about the need for surgery, and assessing post-operative outcomes. Photographic documentation also helps distinguish true growth from fluctuations in conjunctival injection that can make the pterygium appear larger during periods of active inflammation.
Treatment Approach
At Palamu Neuro & Eye Care, Palamu, Dr. Dibya Prabha individualises pterygium management based on lesion size, growth rate, proximity to the visual axis, degree of induced astigmatism, severity of symptoms, and the patient's visual needs and cosmetic concerns. Management spans from conservative observation to surgical excision with conjunctival autograft.
- Medical Symptom Relief
- For small growths, prescribing frequent artificial tears and mild anti-inflammatory drops.
- Advanced Surgical Excision
- Performing a specialized microsurgery to completely remove the growth when it threatens vision.
When to See a Doctor
- !You notice a fleshy growth on your eye that is progressively moving towards the coloured part (cornea), especially if it has grown noticeably over several months
- !Your vision becomes blurred or distorted, or you notice a change in the shape of objects, suggesting induced astigmatism from the pterygium
- !You experience persistent redness, irritation, or a foreign body sensation in one or both eyes that does not resolve with over-the-counter eye drops
- !The growth is causing significant cosmetic concern that affects your self-confidence in social or professional settings
- !You have a pterygium that has been previously operated upon but appears to be growing back with redness and thickening at the surgical site
- !You work outdoors in farming, construction, or other occupations with high UV exposure and want a screening examination to check for early pterygium or other UV-related eye conditions
Frequently Asked Questions
What is pterygium (nakhuna) and why does it develop?
Pterygium, commonly called nakhuna in Hindi due to its nail-like appearance, is a benign, wing-shaped overgrowth of conjunctival tissue that extends onto the cornea. It typically develops on the nasal side of the eye, though it can appear on the temporal side as well. The primary cause is cumulative ultraviolet (UV) radiation exposure, which induces elastotic degeneration of the conjunctival stroma. Additional risk factors include chronic exposure to dust, wind, and dry heat — all of which are prevalent in Jharkhand's climate. Pterygium is far more common in populations living near the equator and in those with outdoor occupations such as farming and construction. At Palamu Neuro & Eye Care, Palamu, Dr. Dibya Prabha sees a high prevalence of pterygium among agricultural workers and outdoor labourers from across Jharkhand, Bihar, and adjoining states. While pterygium is non-cancerous, it can progressively grow across the cornea, obscuring the visual axis and inducing corneal astigmatism that distorts vision.
When does a pterygium need surgery?
Dr. Dibya Prabha at Palamu Neuro & Eye Care recommends surgical excision when the pterygium meets any of these criteria: it is progressively growing towards the centre of the cornea and threatening the visual axis; it has already begun to cover the pupillary area and reduce vision; it is inducing significant astigmatism confirmed by corneal topography; it is causing persistent irritation, redness, or foreign body sensation that does not respond to lubricants; it is restricting eye movements due to symblepharon formation; or the patient desires removal for cosmetic reasons. Small, asymptomatic pterygia that are not progressing can be managed conservatively with UV-protective sunglasses, lubricating eye drops, and periodic monitoring. Dr. Prabha emphasises that surgery performed before the pterygium reaches the visual axis yields the best visual outcomes and lowest recurrence rates.
What surgical technique does Dr. Dibya Prabha use for pterygium removal?
Dr. Dibya Prabha performs pterygium excision with conjunctival autograft, which is the gold standard technique with the lowest recurrence rate (approximately 2–5% versus up to 40–50% for bare sclera excision). The procedure involves carefully dissecting and removing the pterygium tissue from the corneal surface and underlying sclera, then harvesting a healthy piece of conjunctival tissue from the superior bulbar conjunctiva of the same eye. This autograft is secured over the bare scleral defect using fibrin glue or fine sutures. The graft acts as a biological barrier that prevents fibrovascular tissue from re-invading the cornea. The surgery is performed under local anaesthesia as a day-care procedure at a partnered surgical facility in Palamu, and patients go home the same day with an eye patch. Dr. Prabha provides comprehensive post-operative care including topical antibiotic-steroid drops, lubricants, and scheduled follow-up visits.
Can pterygium come back after surgery, and how is recurrence prevented?
Recurrence is the most significant long-term concern after pterygium surgery. With the conjunctival autograft technique that Dr. Dibya Prabha uses, the recurrence rate is reduced to approximately 2–5%. This is dramatically lower than the 40–50% recurrence rate seen with older bare sclera techniques. To further minimise recurrence, Dr. Prabha recommends strict UV protection with wraparound sunglasses post-operatively, regular use of preservative-free lubricating drops, and avoidance of dusty and windy environments during the healing period. In cases where recurrence does occur, she may consider adjunctive therapies such as topical mitomycin C or conjunctival rotation flaps. Early follow-up after surgery is critical because most recurrences develop within the first six months. Dr. Prabha schedules regular post-operative reviews at Palamu Neuro & Eye Care to detect and manage any early signs of recurrence.