This retrospective case series describes the demographic features, clinical characteristics and management of cases of childhood pterygium seen during more than a decade at one eye institute in India. The authors conclude that development of pterygium is rare but a definite possibility in children younger than 16 years. Most cases required conservative management. However, the authors were not able to identify any specific predisposing factors, either environmental or familial, as contributing to childhood pterygium.
Subjects were 19 children (26 eyes) under the age of 16 years presenting with pterygium at a single tertiary care center between January 2000 and August 2011. This was out of a total of 329,049 children seen during the same period, equivalent to a hospital incidence of approximately 0.006 percent. The authors believe this is the largest series reporting the presence of pterygium in this age group.
Ten of the patients were girls. The mean age at presentation was 10.6 years and ranged from 2 to 15 years. Seven patients (37 percent) had bilateral involvement. Most children presented with a complaint of a progressive fibrovascular mass in the eye. None of the cases had familial history of pterygium.
The median refractive astigmatism was -0.5 diopter cylinder. All of the eyes had primary pterygium, except for one, which was recurrent. Eight-five percent of the eyes were managed conservatively, with four (15 percent) requiring surgery, which consisted of pterygium excision with conjunctival-limbal autograft with fibrin glue application.
Follow-up of surgical cases ranged from 5 to 38 months (median 6 months). One operated case recurred one year after surgery.
The authors conclude that while pterygium was associated with mild refractive astigmatism in the majority of cases, its potential to cause significant astigmatism and, hence, amblyopia should be kept in mind. They say that whenever indicated, the technique of pterygium excision with fibrin glue-assisted conjunctival-limbal autograft may be useful. Although the exact predisposing factors, either environmental or potential genetic, could not be identified in this series, a larger community-based cohort with a longer follow-up period would probably contribute to a better understanding of childhood pterygium.