Contents

Guide to Pinguecula (& How to Treat It)

Pinguecula are growths of fat, protein, or calcium on the conjunctiva. (Learn More) They are caused when the eye is exposed to sand, dust, and ultraviolet rays.

Pinguecula are harmless. They usually only require eye drops and better protection to dissipate and return the eye’s appearance to normal. (Learn More)

Some patients might experience discomfort from the growths, so they might be prescribed special contact lenses. Surgery is an option, but it is mostly done for cosmetic purposes. More often than not, basic care will resolve pinguecula. (Learn More)

What Is Pinguecula?

The term “pinguecula” refers to a pyramid-like growth that appears as a yellow discoloration on the conjunctiva (the clear, thin membrane covering part of the front of the eye and the inner surface of the eyelids). It is a deposit of protein, fat, or calcium that is found close to the edge of the cornea. In fact, the word “pinguecula” comes from a Latin word that originally means “fatty.”

Typically, pinguecula form on the surface of the eye that is closest to the nose, but they can occur on the side closer to the ear as well.

Causes and Treatments

Pinguecula is thought to be caused by a combination of dry eyes and exposure to wind, dust, or ultraviolet light from the sun. For this reason, pinguecula is sometimes known as “surfer’s eye,” and it is most commonly found among people who live in tropical climates. Any constant irritation to the eye can lead to pinguecula, regardless of location or activity, however.

Generally speaking, there are some simple ways to protect the eye from the most straightforward risk factors.

  • Wear sunglasses to protect the eyes from ultraviolet light.
  • Wear glasses or goggles to keep dust out.
  • Use artificial tears to lubricate the eyes and help them maintain moisture.

Eye Protection

While wearing protective lenses on sunny days seems obvious, people at risk for pinguecula — such as those who come into contact with a lot of dust and sand or those who have dry eyes in general — might want to wear sunglasses on cloudy days. The sun’s UV rays can easily penetrate cloud cover, and this can precipitate the formation of pinguecula even without direct sunlight.

Sunglasses with wraparound frames offer the best protection since regular frames don’t block all the sunlight the eyes can be exposed to.

Another option might be to wear photochromic lenses, which block out 100 percent of ultraviolet radiation. They are designed to protect the eyes from the harmful high-energy blue light by automatically darkening when coming into contact with that level of sunlight.

The beach is not the only place where a person might have enough risk conditions for the formation of pinguecula. ABC News explains that during winter, fresh snow can reflect up to 80 percent of the ultraviolet radiation coming from the sun. People who ski, snowboard, or spend a lot of time in the snow should wear well-fitting ski goggles to avoid snow blindness and to protect their eyes from absorbing enough UV radiation that it causes pinguecula to grow.

Dry Eyes and Eye Drops

Dry eye disease can also be a contributing factor to the development of pinguecula. They tend to form in middle-aged or older people who spend a lot of time in the sun, but it is not unheard of for pinguecula to form in younger adults or even children. Anybody who spends a lot of time in the sun — without wearing sunglasses, hats, goggles, or anything else to protect their eyes — is at risk for developing pinguecula.

If the pinguecula is advanced enough to cause redness and swelling in the eye (the result of extra blood vessels forming in the conjunctiva), a doctor may recommend steroid eye drops. The eye drops can also help to counter the feeling of a physical object (like dust or sand) in the eye. Surgery is not usually needed for pinguecula, but patients might qualify for surgery if the eye drops take too long to work or if they need immediate relief.

Pingueculitis and Scleral Contact Lenses

In particularly bad cases, the pinguecula can become inflamed and swollen, leading to a condition known as pingueculitis. The American Family Physician explains that pingueculitis can be treated with artificial tears and mild topical steroids if necessary. This should cause the swelling to recede, and it might remove the pinguecula entirely; however, if the patient does not want to wait, surgery is an option.

Additionally, if pinguecula or pingueculitis causes chronic irritation, or the pinguecula interferes with contact lenses, surgery might be a consideration.

Another treatment option is scleral contact lenses. They cover both the cornea and a large part of the sclera (the white part of the eye). This helps to protect the growth from further exposure to UV rays. This will break up the protein, fat, or calcium deposit and cause the pinguecula to dissipate. This might be an option for people whose pinguecula interferes with the application of their regular contact lenses since scleral contact lenses “completely vault the cornea,” bypassing the problems posed by an irregular corneal surface.

People who have pinguecula experience an itching and burning sensation in their eyes, like feeling like they have sand or grit caught on their eye. This might be how the pinguecula started, but it is not actually pinguecula itself. The formation of the pinguecula can make their vision blurry.

Pinguecula vs. Pterygia

Occasionally, pinguecula is confused with another form of eye growth called pterygia. Sometimes the two are mentioned together, but they are distinct conditions.

Pterygia is the growth of fleshy tissue that can start as a pinguecula, but it grows large enough to cover the cornea and affect vision. Pinguecula do not grow, do not cover the cornea, and do not affect vision.

The causes for both pterygium and pinguecula are the same (exposure to the sun’s UV rays, exposure to sand, and dry eyes), but their respective developments and prognoses are different. In 1979, a study of people with pinguecula who live in the Arctic Circle clarified that pinguecula and pterygium are “two different disorders.”

What Should I Do About Pinguecula?

Despite the discomfort and distress of seeing an unusual growth on the eye, pinguecula are noncancerous and generally not a cause for concern. They can be easily treated, and lifestyle changes can help return the eye to its normal appearance.

Healthline points out that there are rarely any long-term consequences of a pinguecula. They have been known to grow back after surgery, especially if the patient continues to expose their eyes to dust, sand, and UV rays.

Pinguecula are benign, but if they change in size, shape, or color, or if they cause significant itching or burning to the eyes (beyond what is to be expected from pinguecula), a patient should report this to their doctor immediately.

Pinguecula. ScienceDirect.

Six Things to Know About Pinguecula and Pterygium. (July 28, 2016). American Academy of Ophthalmology.

Artificial Tears: How to Select Eye Drops for Your Eyes. (February 11, 2016). Mayo Clinic.

Jamie Chung Says Pinguecula Is the Eye Problem That Scared Her Straight. (September 26, 2017). Shape.

Why You Should Be Wearing Sunglasses in the Winter. (January 29, 2019). ABC News.

Everything You Need to Know About Snow Blindness. (October 18, 2018). Healthline.

Acute Red Eye. (September 15, 2007). American Family Physician.

Scleral Contact Lenses. (February 13, 2018). Verywell Health.

Getting Creative With Scleral Lenses: Part 1. (January 25, 2012). Review of Cornea & Contact Lenses.

What Is a Pinguecula and a Pterygium (Surfer’s Eye)? (September 1, 2017). American Academy of Ophthalmology.

Prevalence of Pinguecula in Greenland and in Copenhagen, and Its Relation to Pterygium and Spheroid Degeneration. (February 1979). Acta Ophthalmologica .

Pinguecula. (November 21, 2017). Healthline.

Pinguecula

Pinguecula treatment may involve eye drops for minor cases or surgical removal for more serious conditions that may affect the vision. Our doctors prescribe medical-strength eye drops and ointments when necessary and use the safest and most advanced surgical methods when surgery is required. If you notice a small bump in the white area of your eye, you may have a pinguecula that needs treatment. Our doctors can diagnose pinguecula with a simple eye exam at our Austin, TX, office.

Non-Surgical Treatment Options

Changes in the conjunctiva tissue of the eye can lead to the formation of a pinguecula. As we age, our conjunctiva tissue changes, making us more susceptible to growths like pinguecula. Environmental factors, such as dust, wind, or sun exposure, can also contribute to these changes.

Pinguecula are usually yellow in color and form on the white portion of the eye closest to the nose. The most common symptom is a feeling of an eyelash or other debris in your eye. Your eye may also feel dry or itchy and appear red or inflamed.

The vast majority of pinguecula cases are mild and require non-surgical treatments like eye drops. After our doctors have conducted a full examination of the eye, they can prescribe eye drops or topical ointments.

Surgical Pinguecula Treatment

Less frequently, surgery is recommend to remove the pinguecula. We may recommend surgical treatment when the growth:

  • Is close to the cornea, threatening to affect vision
  • Causes serious discomfort
  • Makes wearing contact lenses uncomfortable or makes them fit incorrectly
  • Affects the aesthetics of the eye

What is a pinguecula?

Conditions

By Amy Hellem; reviewed by Brian S. Boxer Wachler, MD

A pinguecula (pin-GWEK-yoo-lah) is a yellowish, slightly raised thickening of the conjunctiva on the white part of the eye (sclera), close to the edge of the cornea.

Pingueculae are non-cancerous bumps on the eyeball and typically occur on top of the middle part of the sclera — the part that’s between your eyelids and therefore is exposed to the sun.

Usually pingueculae affect the surface of the sclera that’s closer to the nose, but they can occur on the outer sclera (closer to the ear) as well.

Causes

Ultraviolet radiation from the sun is the primary cause of the development of pingueculae, but frequent exposure to dust and wind also appear to be be risk factors. Dry eye disease also may be a contributing factor and can promote the growth of pingueculae.

Pingueculae are more common in middle-aged or older people who spend a lot of time in the sun. But they also can occur in younger people and even children — especially those who are often outdoors without sunglasses or hats to protect their eyes from the sun’s UV rays.

To decrease the risk of pinguecula, it’s important to wear sunglasses outdoors even on overcast and cloudy days, because the sun’s UV rays penetrate cloud cover. For the best protection, choose sunglasses with a wraparound frame design, which block more sunlight than regular frames.

Signs and symptoms

In most people, pingueculae don’t cause many symptoms. But when they do, those symptoms usually stem from a disruption of the tear film. Because a pinguecula is a raised bump on the eyeball, the natural tear film may not spread evenly across the surface of the eye around it, causing dryness. This can cause dry eye symptoms, such as a burning sensation, stinging, itching, blurred vision and foreign body sensation.

Another symptom of pingueculae is the appearance of extra blood vessels in the conjunctiva that covers the sclera, causing red eyes.

In some cases, pingueculae can become swollen and inflamed. This is called pingueculitis. Irritation and eye redness from pingueculitis usually result from excessive exposure to sunlight, wind, dust or extremely dry conditions.

Sometimes people confuse pingueculae with eye growths called pterygia, but they are different. Learn more about what a pterygium is.

Treatment

Pinguecula treatment depends on how severe the symptoms are. It’s especially important for anyone with pingueculae to protect their eyes from the sun, since it’s the sun’s harmful UV rays that causes pingueculae to develop in the first place and encourages them to keep growing.

To help protect your eyes from pingueculae, shield your eyes from the sun whenever you are outdoors in daylight (even on overcast days because the sun’s UV rays penetrate clouds).

Consider purchasing photochromic lenses, which darken automatically in sunlight and provide 100 percent UV protection. Photochromic lenses also shield your eyes from harmful high-energy blue light. Ask your eye care professional for details.

If a pinguecula is mild but accompanied by dry eye irritation or foreign body sensation, lubricating eye drops may be prescribed to relieve symptoms. Scleral contact lenses sometimes are prescribed to cover the growth, protecting it from some of the effects of dryness or potentially from further UV exposure.

Pingueculae also can lead to localized inflammation and swelling that is sometimes treated with steroid eye drops or non-steroidal anti-inflammatory drugs (NSAIDs). If dry eye is the cause of the pinguecula, eye drops formulated to treat dry eyes also may be prescribed.

Surgical removal of a pinguecula may be considered if it becomes especially uncomfortable, if it interferes with contact lens wear or blinking or if it is cosmetically bothersome.

Finally, although a pinguecula is non-cancerous, you should report any changes in size, shape or color of any bump on your eyeball to your eye doctor.

Page updated April 2019

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Amy Hellem

Amy Hellem is a writer, editor and researcher who specializes in eye care and other medical fields.

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Pinguecula Removal with WhiterEyes® for Improved Confidence

Frequently Asked Questions:

  • What are Pingueculae?
  • How did I get these growths?
  • How can I avoid Pingueculae from occurring?
  • Are there treatments available to remove Pingueculae?
  • What makes Dr. Brian’s procedure unique?
  • How can I determine if I’m a candidate for WhiterEyes® Conjunctivoplasty?
  • Is it a problem that I live out-of-town?
  • How will I feel after I receive the treatment?

What are Pingueculae?

Pingueculae are growths that form on or within the clear membrane (conjunctiva) that covers the eye. They are typically yellow or brown areas of thickening on the inner corner of the eyes over the white area of the eye. They are benign (non-cancerous) and do not pose a significant health concern, although if left untreated they can grow and are often associated with Dry Eye, Irritation, and Increased Redness. They can also lead to difficulty wearing your Contact Lenses.

The worst part for most patients is the appearance of these growths cause their eyes to look unhealthy. Although you may feel normal the appearance of these growths decreases self-esteem. Patients report that the avoid social interactions, due to comments from others about the appearance of their eyes.

How did I get these growths?

They can be caused by lifetime of sun exposure and to other environmental factors like pollution, smoke, and dust. Prolonged exposure to sunlight without protection is considered one of the primary causes.

How can I avoid Pingueculae from occurring?

Protecting the eyes with good quality 100% UV blocking sunglasses is one of the best ways to prevent Pingueculae. Once you notice these growths, protecting your eyes can help to slow the progression of the growths. It is suggested to not only wear sunglasses, but consider wearing a hat when outdoors for more than 20 minutes. Also, instilling artificial tears and keeping the eyes lubricating can help.

Dr. Brian conducted a recent study and determined driver and passenger side windows of doors often do not have proper UV coating. He recommends having a clear UV film placed on the side windows of your car to reduce UV exposure while driving. Other studies have shown that skin cancer on the face and left-sided cataracts are more common because of UV exposure in the car while driving.

Are there treatments available to remove Pingueculae?

Dr. Brian’s WhiterEyes® Conjunctivoplasty procedure is extremely effective in removing these unpleasant growths. A multitude of patients have already experienced the positive effect of clear, whiter eyes in their lives thanks to WhiterEyes® Conjunctivoplasty.

This 20-minute procedure is 100% no-stitch out-patient procedure performed in the comfort of Dr. Brian’s procedure room at his office. No scary surgery center or hospital is required for this procedure. Usually you can resume work and your normal routine within 2-7 days. The results are typically fully seen 8 – 18 weeks after the procedure.

Why is Dr. Brian’s procedure better than other doctors?

Dr. Brian’s technique is more than just the removal of tissue growths. He also pays special detail to address and remove the excessive blood vessels and/or discoloration that are secondary to the growths. Most other doctors are not concerned with the cosmetic appearance of the eye beyond the growths.

In addition, Dr. Brian is able to perform this procedure WITHOUT the need for sutures. This dramatically reduces the risk for visible scarring and irregular tissue growth. Dr. Brian is very meticulous and carefully addresses each layer of the tissue to provide the best cosmetic result.

How do I know if I am a candidate for treatment?

If you are local to the Beverly Hills/Los Angeles area, please call 310-594-5209 to schedule a thorough consultation. Dr. Brian will personally meet with you and review your options, providing you with an individualized treatment plan.

What can I expect after the procedure?

Patients normally return to work and their normal activities within 2-7 days after the procedure. Some patients may note a scratchy or irritated feeling of the eyes for a few days, as well as some light sensitivity. A small number of patients may have some recurrence of blood vessels around the site that pinguecula growths were removed. It is possible the growths could begin to reappear, this is why we strongly suggest wearing sunglasses outdoors and while driving. More rare risks with the procedure are infection and scleral thinning, it is important you follow eye drop and follow-up exam recommendations to avoid these risks. We routinely reviewed records to evaluate for other risks. The most recent review looked at 1327 eyes that underwent WhiterEyes® Conjunctivoplasty. This reviewed identified 3 patients that experienced light sensitivity beyond 6 months (0.2%).

Pinguecula regrowth with Dr. Brian’s WhiterEyes® Conjunctivoplasty procedure is very low at under 7% – this is a very low rate among all techniques for Pinguecula removal. At the time of your consultation with Dr. Brian, he will discuss the risks of the WhiterEyes® Conjunctivoplasty procedure as well as any of your other questions during your consultation.

It is strongly recommended to complete the postoperative eye drop regimen fully and to always use proper protection from sunlight (sunglasses and hats), in order to maximize the long-term effects of the WhiterEyes® Conjunctivoplasty procedure. Another important step is instilling artificial eye drops whenever your eyes feel dry, or when you know they may be exposed to harsh environmental conditions (prolonged sun, wind, dust, etc.).

Are You a Candidate?

You can e-mail a close-up picture of your eyes to learn if WhiterEyes® Conjunctivoplasty might be right for you. Simply e-mail to [email protected] and request a “Photo Review for WhiterEyes® Conjunctivoplasty.”

*Final candidacy will be determined during an exam with Dr. Brian.

Remember when you eyes looked healthy and refreshed. These pictures show normal, natural healthy eyes.

We understand how bloodshot eyes and eyes with yellowish growths or brown pigmentation may keep you from looking healthy, alert and at your best.

Most patients are amazed to learn this procedure only takes 20-25 minutes per eye. This can improve the appearance of eyes, your self-esteem… and your general outlook on life.

In most cases, this procedure is performed by removing the thin membrane (conjunctiva) that covers the whites of the eyes and holds most of the unsightly red veins and yellow growths or brown pigment material. A new clearer membrane grows back in its place. Afterwards your eyes can become whiter and brighter. The most common added benefit is that people even feel their self-confidence has improved, noting they are now finally able to look people in the eyes again. Others often comment that patients undergoing WhiterEyes® Conjunctivoplasty seem to appear more well-rested and refreshed.

WHO IS HAVING WhiterEyes® Conjunctivoplasty? WhiterEyes® Conjunctivoplasty is not just a procedure for celebrities. Good people like yourself are having this procedure. ANYONE who is tired looking at their bloodshot, yellow or brown-spotted eyes. People from all over the world, not just the United States are flying in weekly for an easy 3-day visit for Dr. Brian to help them.

A brief list of patients who had WhiterEyes® Conjunctivoplasty include: medical personnel (doctors, surgeons, nurses, pharmacists, psychologists), attorneys, para-legals, law enforcement, supermodels, actors, TV hosts, professional athletes, sales people, consultants, executives, office workers, financial planners, accountants, mothers, fathers, retired men and women, drivers, manual laborers, gardeners, etc. And the list goes on and on.

Are you wondering, “Who is Dr. Brian?” .

WhiterEyes™ Conjunctivoplasty can also be used to remove pterygium (which is a pinguecula that has grown over cornea, the clear window covering the iris) as shown below:

Before Pterygium Removal

1 Month After Pterygium Removal

Take a moment, close your eyes and visualize your life with “whiter eyes.” How good would it feel to not have to rely on those “get-the-red-out” drops like you do now. It’s not just a dream anymore, this could be your new reality.

How to treat and prevent pterygium and pinguecula

November 30, 2017 – Pterygium & Pinguecula

Transcript

“Hey everybody, it’s Dr. Sam. I received a question about pterygium and pinguecula.

Pterygium is an inflammatory process and a degenerative progressive disease on the front part of the eyeball. It is actually a fibrous connective tissue that grows from the inside part of the eye and grows across the cornea.

Pinguecula comes before the pterygium – it is the beginning stages of a pterygium. It turns into a pterygium for a few reasons:

  1. Oxidative stress – if we an accumulation of free radicals, it can spur the growth of pterygium.
  2. Dry, windy, or hot environments – you have a higher incidence of getting a pterygium.

The success rate of surgery is only 40%. So even if you cut it away, it has a very high reoccurrence rate, and commonly grows back even more aggressively than before. So how do you get rid of a pterygium?

  1. I recommend MSM eye-drops. These will soften the connective cell tissue that grows over the eye.
  2. Supplement with eye nutrients that include lutein, zeaxanthin, vitamin C, omega-3 fish oil, trace minerals, taurine, probiotics, prebiotic fiber, and glutathione.
  3. Anti-inflammatory, low-carb, low-sugar, gluten-free diet
  4. Aerobic exercise

These are all important steps that can help dissolve free radical damage and metabolic waste that accumulates in the eye tissue.

There was a research study where researchers found that one of the causes of pterygium had to do with the malfunction of the meibomian glands of the eyelids. These glands produce the oily part of the tears. In this study, they found that people who had meibomian malfunction were at higher risk of developing pterygiums.

Another interesting study came out in the Journal of Molecular Biology where researchers found that curcumin, which is found in turmeric, could suppress and inhibit some of the cells that facilitate pterygium growth. So increasing our intake of curcumin can actually suppress and prevent pterygium growth.

Overall this is not a serious condition. It is a benign situation, though it can definitely distort your vision if it grows over your eyes.”

Effective Dry Eye Treatment for Pinguecula/Pterygium -Surfer’s Eye With TheraLife

Petrygium often causes dry eyes which result in much discomfort and frustration. We are documenting a dry eye treatment for Petrygium that avoids the use of surgery.

What is Petrygium

Pterygium is a growth of thin tissue on the conjunctiva that covers your eyeball. This growth can be slow and extends to cover part of the cornea. This condition is called Pterygium, also referred to as “Surfer’s Eye” because it is caused by extensive exposure to sunlight. In addition, pterygium is often started as a Pinguecula.

What is Pinguecula

Pinguecula is a yellow spot or bump on the corner of your eye that looks like a yellow fat deposit. A pinguecula often gets bigger and develops into a pterygium. When this happens, the friction between your eyelid and the pterygium tissue causes inflammation and result in dry eyes. Dry eye symptoms such as itchy, foreign body sensation and red eyes are common. Therefore, this causes much pain and suffering.

How Do Eye Doctors Treat Pterygium?

Eye doctors often recommend eye drops, and steroid drops for symptom relief. Depending on how severe the dry eye symptoms are, however, eye drops may not work. In addition, steroid drops1 are known to cause side effects such as increased intraocular pressure resulting in Glaucoma, or damages to the liver and kidney.

When the Pterygium growth becomes extensive and large, eye doctors often recommend surgery. However, eye surgeries tend to result in dry eyes afterward due to the invasive nature of the procedure. What is more, other complications after Pterygium surgery has been documented2. Therefore, avoid surgery would be highly desirable if there are other non-invasive alternatives. TheraLife presents a dry eye treatment opportunity for Pterygium without the use of surgery.

What Are Chronic Dry Eyes?

Chronic dry eyes happens when one do not produce enough tears (tear insufficiency), or tear is too thin resulting in evaporative dry eye. The causes for dry eyes include but not limited to computer over use, contact lens wear, menopause, aging, and autoimmune diseases. The symptoms of chronic dry eyes include blurry vision, foreign body sensation, light sensitivity, red irritated eyes, puffy eye lids, and eye pain. Besides, chronic dry eyes also lead to complications of Blepharitis, Meibomian Gland Dysfunction (MGD), cornea abrasions and more. What is more, chronic dry eyes left untreated could lead to blindness. All these symptoms can be involved in people with Pterygium.

How Does TheraLife Treat Dry Eyes Cause by Pterygium?

TheraLife Eye capsules are an effective and powerful treatment for chronic dry eyes, including the symptoms caused by pterygium. TheraLife Eye capsules increases tear production, reduce inflammation, and ease eye pain caused by surfer’s eye. It restores tear productions from inside out. Better yet, it is 100% natural, suitable for vegans.

Learn more how TheraLife Eye works.

A personal story from one of TheraLife’s customers

“I developed pterygium(surfer’s eye) in both eyes in 2006 due to dry eyes. I also started menopause – the hormoneimbalance makes dry eye symptoms worse. My Tear Breakup Test was only 1 sec. Normal is between 10-15. I alsohad MGD (meibomian gland dysfunction) where my oil glands are clogged. I started taking Theralife Eye capsules,krill and fish oil; hot compresses daily, and a healthy smoothie to fortifynutrients for the eyes. I used a gel compress over my eyes to keep my eyelidsclosed. I had a high-stress job for years which makes dry eye symptoms worse.My cholesterol level is now normal- hopefully, this will prevent furtherclogging of the Meibomian oil glands. There are many factors to affect dry eyes. However, since I started theTheraLife protocol, it is making a difference. I am making more of my own natural tears, and pterygium stopped being aproblem.

I am grateful to have found TheraLife.”

A. Lurenci- California, USA

1.Long Term and Intensive Use of Ophthalmic TopicalCorticosteroids and the Risk of Positive Doping Test in Athletes: A Case Report https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594141/

2.Seriouscorneoscleral complications after pterygium excision with mitomycin C– Br J Ophthalmol. 2002 Mar; 86(3): 357–358.

Pterygium & Pinguecula Surgery

Dr. Cavanaugh routinely treats patients with eye conditions such as pterygia and pingueculae

Funny Names: What are They?

Pterygium

A pterygium is a wedge-shaped fibrovascular growth of conjunctiva (the surface tissue of the white of the eye) that extends onto the cornea. Pterygia are benign lesions that can be found on either side of the cornea. Prolonged exposure to ultraviolet light contributes to the formation of pterygia. Pterygia are more often seen in people from southern or tropical climates, but can be found in others as well. Like sun damage to skin, Pterygium often take many years of cumulative sun exposure to develop and do not come on instantly.

Pingueculae are yellowish, slightly raised lesions that form on the surface tissue of the white part of your eye (sclera) close to the edge of the cornea. They are typically found in the open space between your eyelids which also happens to be the area exposed to the sun. While pingueculae are more common in middle-aged or older people who spend significant amounts of time in the sun, they can also be found in younger people and even children — especially those who spend a lot of time in the sun without protection such as sunglasses or hats.

Pterygium / Pinguecula Symptoms

Pterygia & pingueculae are often asymptomatic, and many do not require immediate treatment. However, both conditions can become red and inflamed from time to time. Large or thick pterygia / pingueculae may bother some people due to a persistent foreign body sensation in the eye. As a pterygium progresses, it can begin to affect the curvature of your cornea and in turn lead to blurry vision.

Pterygium / Pinguecula Treatment

Pterygium Treatment
Treatment depends largely on the size and extent of the pterygium, as well as its tendency for recurrent inflammation. Evaluation by Dr. Cavanaugh will help determine the most optimal treatment in each case. If a pterygium is small but becomes intermittently inflamed, your doctor may recommend a trial of a mild steroid eye drop during acute inflammatory flares. In some cases, Dr. Cavanaugh may recommend surgical removal of the tissue.

The recommendation for removal will likely be advised if the pterygium is growing far enough onto the cornea to threaten your line of vision. A pterygium may also be removed if it causes a persistent foreign body sensation in the eye, or if it is constantly inflamed and irritating. In addition, some pterygia grow onto the cornea in such a way that they can pull on the surface of the cornea and change the refractive properties of the eye, causing astigmatism. Removing the pterygium may decrease the astigmatism.

The removal may take place in a procedure room or operating room setting. The pterygium is carefully dissected away. In order to prevent regrowth of the pterygium, Dr. Cavanaugh may remove some of the surface tissue of the same eye (conjunctiva) and suture it into the bed of the excised pterygium. Also, an anti-metabolite such as Mitomycin-C may be applied to the site. Postoperatively, your doctor may recommend some steroid eye drops for several weeks to decrease the inflammation and prevent regrowth of the pterygium.

Pinguecula Treatment
Pinguecula treatment depends on severity of symptoms. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for those with mild pingueculitis to relieve dry eye irritation and foreign-body sensation, whereas steroid eye drops or nonsteroidal anti-inflammatory drugs may be needed to relieve significant inflammation and swelling.

Surgical removal of the pinguecula may be considered in severe cases where there is interference with vision, contact lens wear, or blinking. Frequently, pingueculae can lead to the formation of pterygia.

The Improvement of Dry Eye Symptoms after Pinguecula Excision and Conjunctival Autograft with Fibrin Glue

Abstract

Purpose. To evaluate the association between pinguecula excision and subsequent improvement in dry eye syndrome. Methods. We included 30 consecutive patients with primary nasal pinguecula and dry eye symptoms undergoing ocular surgery for the first time. Criteria for pinguecula excision surgery were nasal location, yellowish color, and protrusion of conjunctiva at least 2 times thicker than adjacent normal conjunctiva as measured by anterior segment optical coherence tomography. Our primary outcomes were 3-month postoperative changes in tear film breakup time (TBUT), Schirmer test, and a dry eye symptom score. Results. 30 eyes from 30 different patients (12 men and 18 women) underwent pinguecula excision and conjunctival autografting using fibrin glue. The mean age was 42.5 ± 8.35 (range 28–63) years. The preoperative protrusion ratio of pinguecula was 2.33 ± 0.28 (range 2.00–2.90). Mean preoperative TBUT, Schirmer test, and dry eye symptom scores were 5.10 ± 1.27 seconds, 6.07 ± 2.27 mm, and 2.80 ± 0.76 points. Mean postoperative 3-month TBUT, Schirmer test, and dry eye symptom scores were 7.80 ± 1.13 seconds, 7.27 ± 2.02 mm, and 0.30 ± 0.47 points, respectively. The median pre- and postoperative changes were found to be statistically significant by Wilcoxon signed-rank tests for TBUT, Schirmer test score, and dry eye symptom score. Conclusion. Surgical excision of pinguecula and conjunctival autograft using fibrin glue is an effective and safe method to improve symptoms of dry eye syndrome.

1. Introduction

A pinguecula is a round, yellowish, elevated fleshy tissue on the bulbar conjunctiva. It is more common in nasal limbal conjunctiva and often contains deposits of protein, fat, or calcium . Although pinguecula are in most cases asymptomatic, they may cause symptoms of dryness or burning by disrupting the ocular tear film distribution, particularly when they become protruded .

The primary reason pinguecula is excised is for cosmesis. Argon photocoagulation has shown good results for small, nonvascularized pinguecula , whereas surgical excision and sutureless conjunctival autografting using fibrin glue have shown good outcomes for high-grade pinguecula . Grading of pinguecula is dependent on office-based assessment of pinguecula area and thickness. In the past, it was difficult to measure the thickness of pinguecula accurately, but recently, anterior segment optical coherence tomography (AS-OCT) has been used to quickly and accurately determine dimensions .

In our clinical practice, similar to published reports after pterygium excision, we have consistently found improvement in patients’ dry eye symptoms after pinguecula excision. Interestingly, there is scant literature on the association between pinguecula and dry eye. The contribution of this study is that we examine the relationship of pinguecula and dry eye pre- and postoperatively in a quantitative manner using accurate high-resolution OCT data and changes in tear film breakup time (TBUT), Schirmer tests, and dry eye symptom scores.

2. Methods

This study is a retrospective chart review of patients having excision of high-grade primary pinguecula for cosmetic reasons and/or irritation. We included 30 consecutive patients meeting inclusion criteria from May 2016 to April 2017. Inclusion criteria were patients with a noninflamed, vascularized nasal pinguecula, dimensions greater than 2.0 mm × 2.0 mm, and thickness greater than 2 times that of the adjacent conjunctiva. Tissue thicknesses were measured using AS-OCT (RS-3000 Advance, Nidek Co LTD, Japan) (Figure 1). The pinguecula protrusion ratio is the thickness of the pinguecula divided by the thickness of adjacent normal conjunctiva. In cases of bilateral pinguecula, the eye with more symptoms was selected for surgery. Patients with active surface inflammation such as pingueculitis or previous ocular surface surgeries were excluded. Patients were made aware of the risks and benefits of surgery and of nonsurgical treatment modalities. We adhered to the tenets of the Declaration of Helsinki, and appropriate Institutional Review Board/Ethics Committee approvals were obtained.

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(d) Figure 1 Slit lamp photograph and respective anterior segment optical coherence tomography of two patients. (a) A 27-year-old male patient with yellowish, nasal, protruded pinguecula. (b) AS-OCT of (a) showing pinguecula thickness (yellow star) more than 2 times the adjacent conjunctival thickness (distance between arrow and arrowhead). (c) A 32-year-old female patient with nasal pinguecula less protruded than that in the patient in (a). (d) AS-OCT of (c) shows pinguecula thickness less than 2 times the adjacent conjunctival thickness (distance between conjunctival epithelium (arrow) and conjunctiva-sclera junction (arrowhead)). Yellow star: pinguecula; arrow: conjunctival epithelium; arrowhead: conjunctiva-sclera junction.

All surgeries and pre-/postoperative evaluations were performed by a single surgeon (J. W. K.) using a standard technique . Under topical anesthesia (0.05% proparacaine hydrochloride, Alcaine; Alcon, Ft. Worth, TX), the border of the pinguecula was first marked with gentian violet, and the outlined pinguecula was then gently excised from the underlying tenon tissue or sclera using Vannas scissors. After measuring the dimensions of the resulting defect, the superior conjunctiva was marked to the corresponding size and a free conjunctival graft was harvested. The graft was then transferred to the defective area and glued to the place using fibrin adhesives (Tisseel; Baxter, Westlake Village, CA). We excised only the pinguecula without additional margins. There was minimal tissue retraction, so graft dimensions were matched to the same dimensions of the original defect . The cornea was covered with a therapeutic contact lens (Johnson and Johnson Acuvue 1 day, −0.50 diopter, 14.2 mm in diameter, 8.5 mm in base curve), and patients received levofloxacin (Cravit; Santen Pharmaceutical Company, Osaka, Japan) and 1% prednisolone acetate (Pred Forte; Allergan, Irvine, CA) eye drops four times daily for 1 week and then three times per day for 1 week. The therapeutic contact lens was removed at postoperative 1 week.

We measured preoperative and 1- and 3-month postoperative changes of TBUT, Schirmer test, and dry eye symptom scores. 3 months was considered to be a sufficient amount of time for post-op healing and prednisolone acetate drop washout. The TBUT was measured by asking the patient to look nasally and then staining the superotemporal bulbar conjunctiva with fluorescein (Fluorescein paper; Haag-Streit Diagnostics, Koeniz, Switzerland). The breakup time of the corneal tear film after one blink was recorded . TBUT was reported as the average of 3 consecutive measurements. The Schirmer test was performed without topical anesthesia, whereby a Schirmer strip was placed at the inferotemporal fornix, and the wet length of the strip was measured after 5 minutes . Patients were asked to grade cumulative ocular symptoms of dryness, stinging, foreign body sensation, and redness into one of the 5 following categories: 0 (asymptomatic); 1 (occasional symptoms but no obstacle to daily life); 2 (continuous symptoms but no obstacle to daily life); 3 (continuous symptoms with interference of daily life); 4 (continuous symptoms with interference of daily life and desiring surgical treatment). After the postoperative 1- and 3-month evaluations, patients were followed up in roughly 3-month intervals for a range of 10–15 months in order to evaluate for discomfort and/or recurrences. Statistical analyses were conducted using SPSS statistical software (version 21.0, SPSS Inc., Chicago, IL). The Wilcoxon signed-rank test was used to test preoperative and postoperative differences in our outcome variables. Linear correlations were used to assess the association of pinguecula protrusion and preoperative and postoperative changes of our outcome variables. A -value of less than 0.05 was considered statistically significant.

3. Results

From May 2016 to April 2017, 30 eyes of 30 patients (12 men and 18 women) underwent pinguecula excision and conjunctival autografting using fibrin glue. Their mean age was 42.5 ± 8.35(range 28–63) years. Preoperative ophthalmic examination showed a yellowish, raised pinguecula with significant vascularization in each case and a mean protrusion ratio of 2.33 ± 0.28 (range 2.00–2.90). Histologic examination of excised tissues confirmed subepithelial solar elastosis with thinning of the overlying epithelium. The mean postoperative follow-up period was 12.27 ± 1.34 (range 10–15) months. After pinguecula excision with conjunctival autograft, it showed vascular shrinkage and flattening of the conjunctival surface (Figure 2). There was no case of recurrence during the follow-up periods. Mean preoperative TBUT, Schirmer test, and dry eye symptom score were 5.10 ± 1.27 seconds, 6.07 ± 2.27 mm, and 2.80 ± 0.76 points, respectively. At the 1-month postoperative visit, mean TBUT and Schirmer test were 7.63 ± 1.19 seconds and 6.80 ± 2.25 mm, respectively. At the 3-month postoperative visit, mean TBUT, Schirmer test, and dry eye symptom score were 7.80 ± 1.13 seconds, 7.27 ± 2.02 mm, and 0.30 ± 0.47 points, respectively. 3 months after surgery, the dry eye symptom score of 9 eyes was 1 and the remaining 21 eyes was 0. Nonparametric analyses using Wilcoxon signed-rank test confirmed statistically significant changes in the median preoperative and 3-month postoperative TBUT (sig.<0.001), Schirmer test (sig. = 0.001), and dry eye symptom score (sig. <0.001) (Tables 1 and 2).

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(f) Figure 2 Pre- and postoperative slit-lamp biomicroscopic photographs of three patients. A 53-year-old woman with protruded nasal pinguecula (a) underwent surgery and showed vascular shrinkage and flattening of conjunctival surface; 6 months after the surgery (b). A 50-year-old man with nasal pinguecula (c) showed improvement of vascularization and conjunctival protrusion; 4 months after the surgery (d). A 48-year-old woman with prominent nasal pinguecula (e) showed improvement and restored conjunctival surface; 2 months after the surgery (f). Table 1 Clinical profile of the preoperative pinguecula patients. Table 2 Nonparametric Wilcoxon signed-rank test for the preoperative and 3-month postoperative change of dry eye outcome variables. Table 3 Correlation analysis of protrusion ratio of pinguecula and dry eye outcome variables.

4. Discussion

There is a significant amount of research on the association of pterygium and dry eye syndrome , but very little on the association between pinguecula and dry eye, even though pinguecula is more prevalent and its pathophysiology may be different . In this study, we found that all included measures of dry eye syndrome (TBUT, Schirmer test, and dry eye symptom score) improved after surgery. This improvement was statistically and clinically significant. There was objective 3-month improvement postoperatively in average TBUT and Schirmer test scores of 2.7 sec and 1.2 mm, respectively, and subjective improvement from symptoms on average being continuous and impacting quality of life to at worst being occasional and not bothersome.

Previous reports showed improvement in tear film stability after pinguecula and pterygium excision . It was hypothesized that the improvement in dry eye syndrome status after pinguecula surgery results from removal of the physical protrusion causing tear film instability. Most pinguecula-grading systems include quantitative measures of surface dimensions but not protrusion. We found the protrusion of the pinguecula to be statistically significantly correlated with all our dry eye outcome variables. Greater protrusion was moderately correlated with lower TBUT and Schirmer test scores. It was also moderately correlated with higher dry eye symptom scores and a greater postexcision improvement in symptoms. It follows that pinguecula protrusion may affect tear film stability and therefore TBUT, but we also found that tear film production improved postoperatively. This finding is supported by evidence in the literature of lower tear osmolarity after pterygium excision surgery . Pinguecula and pterygium may influence aqueous tear production via friction against the tarsus causing local inflammation and decreasing accessory lacrimal gland secretion. Interestingly, Viso et al. published a study in which pinguecula was not associated with dry eye signs and symptoms . This discrepancy is possibly due to a difference in patient populations; one including a general population and the other a population of patients with high-grade pinguecula referred to our specialty clinic.

Importantly, we found no clinically significant complications after our pinguecula excision surgeries. At a mean follow-up period of 12.3 months, there was not a single recurrence, and all patients were satisfied with their results. With respect to our surgical approach, we preferred using a conjunctival autograft with sutureless fibrin adhesive application rather than a conjunctival rotational flap or reapproximation because the latter technique often requires conjunctival sutures and may result in stretching tension to the wound. The sizes of our conjunctival autograft were relatively small; however, in instances when conjunctiva may be needed for future surgery (e.g., glaucoma filtering surgery), an amniotic membrane graft could also be considered as an alternative to our approach.

Our study has a number of limitations. The study is a retrospective analysis and was not designed to prove the causality of pinguecula excision in improving dry eye syndrome. The study does not include grading of fluorescein staining, an important measure in the study and treatment of dry eye syndrome. We attempted to control for confounders by excluding patients with active inflammation and including a prednisolone acetate washout period of more than 10 weeks. However, we did not include a nonsurgical control group and so symptom improvement may be due to a placebo effect. Lastly, the sample size was not sufficiently large to perform subgroup analyses to examine if the effect varied across different patient demographics.

In conclusion, we accurately measured the protrusion of pinguecula by comparing the relative thickness with adjacent normal conjunctiva using AS-OCT, and we found that protrusion was statistically correlated with preoperative dry eye symptom scores and that the surgical excision of symptomatic pinguecula improved not only cosmesis but also improved dry eye syndrome without any instances of recurrence or other serious complications with properly selected patients. Given the high prevalence of pinguecula , its potential relationship to dry eye syndrome should not be overlooked, especially with significantly protruded lesions.

Data Availability

The patient data used to support the findings of this study are available from the corresponding author upon request.

Ethical Approval

The study protocol was in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Myongji Hospital, Hanyang University College of Medicine, Seoul, Korea (MIRB 2018-05-002–001). Additionally, written informed consent was obtained from all participants.

Consent

Patients provided written informed consent after being given a detailed explanation of the study. The patients agreed to data publication in a journal.

Conflicts of Interest

The authors have no other proprietary or commercial interest in any materials discussed in this article. No conflicting relationship exists for any author.

Authors’ Contributions

JJ designed the study, GR revised the manuscript, TK carried out statistical analysis and pathology analysis, and JWK participated in its design and coordination and helped draft the manuscript. All authors read and approved the final manuscript.

Aetiology

Degenerative conjunctival lesion, usually situated nasally at the limbus
Degeneration of collagen fibres of the conjunctival stroma

  • hyalinisation and granular deposits
  • thinning of overlying epithelium
  • occasional calcification

Predisposing factors

Increasing age (seen in most eyes by age 70)
Published figures of prevalence range from 11-75% (prevalence depends on age and geographical location of the sample)
Long term exposure to UV radiation

  • sunlight (residence at or near the equator, outdoor work, especially on reflective surfaces e.g. sand, concrete, water, snow)
  • welding and other occupational exposure

Male gender (likely to be related to occupational exposure)
Chronic irritation from wind or dust
Contact lens wear

Symptoms

Usually asymptomatic
Possible mild foreign body sensation and redness when inflamed
Occasional cosmetic concern

Signs

Area of conjunctival thickening adjoining the limbus

  • in the palpebral aperture, usually at 3 & 9 o’clock positions
  • more common nasally
  • usually bilateral

Elevated and less transparent than normal conjunctiva
White to yellow colour, fat like appearance, calcification sometimes present
Sometimes slightly more hyperaemic than surrounding conjunctiva
May become inflamed (pingueculitis) causing mild ocular irritation
May lead to Dellen in adjacent cornea
Decreased TBUT

Differential diagnosis

Pterygium

  • easily distinguished because pinguecula does not cross the limbus to involve the cornea
  • pinguecula does not progress to become pterygium; they are two distinct conditions

Conjunctival intraepithelial neoplasia (can resemble a keratinised pinguecula)
Dermoid cyst
Epithelial retention cyst (thin-walled lesion containing clear fluid)
Differentiate from inflammatory conditions, e.g. episcleritis, angular conjunctivitis

Management by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above

Non pharmacological

Reassure patient about benign nature of the lesion (no threat to health or sight)
Advise on UV protection to minimise risk of inflammation

  • brimmed hat, sunglasses in wrap-around style for side protection

Cold compresses when inflamed
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Pharmacological

Ocular lubricants for symptomatic relief (drops for use during the day, unmedicated ointment for use at bedtime
NB Patients on long-term medication may develop sensitivity reactions which may be to active ingredients or to preservative systems (see Guideline on Conjunctivitis Medicamentosa). They should be switched to unpreserved preparations
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Pingueculitis usually responds to a brief course of a ‘non-penetrating’ topical steroid (e.g. fluorometholone, loteprednol) or a topical non-steroidal anti-inflammatory drug (off-licence use)
NB All patients on topical steroid drops or ointment should have their intraocular pressures checked initially, then measured again at 2 weeks and every 4 weeks for 2-3 months (see Clinical Management Guideline on Steroid Glaucoma)
(GRADE*: Level of evidence=moderate, Strength of recommendation=weak)

Management category

B2: alleviation / palliation: normally no referral

Possible management by ophthalmologist

Excision is very rarely warranted
A single case series has described effective cosmetic removed of pingueculae by argon laser photocoagulation

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)

Sources of evidence

Ahn SJ, Shin KH, Kim MK, Wee WR, Kwon JW. One-Year Outcome of Argon laser photocoagulation of pinguecula. Cornea. 2013;32:971-5

Frucht-Pery J, Siganos CS, Solomon A, Shvartzenberg T, Richard C, Trinquand C. Treatment of inflamed pterygium and pinguecula with topical indomethacin 0.1% solution. Cornea. 1997;16:42-7

Frucht-Pery J, Siganos CS, Solomon A, Shvartzenberg T, Richard C, Trinquand C. Topical indomethacin solution versus dexamethasone solution for treatment of inflamed pterygium and pinguecula: a prospective randomized clinical study. Am J Ophthalmol. 1999;127(2):148-52

Lay summary

A pinguecula is a small raised spot, white to yellowish in colour, that sometimes appears on the surface of the eye at the limbus. The limbus is where the white of the eye (the sclera) and the transparent window at the front of the eye (the cornea) meet. If the cornea is imagined as a clock face, a pinguecula will generally form at the three and nine o’clock positions. This condition becomes commoner as people age, so that by 70 years most people have them. Both eyes are usually affected. There is no effect on vision.

This is a mild degenerative condition, due to long-term exposure to ultra-violet (UV) light, either occurring naturally in sunlight or artificially in some occupations. A pinguecula usually causes no symptoms, but if it becomes inflamed it may cause local redness of the eye and irritation or discomfort. Sometimes people complain of the cosmetic appearance.

The optometrist will examine the pinguecula carefully, distinguishing it from other small spots and cysts that sometimes appear on the eye surface in this position. Once the diagnosis is made, the patient will be advised to limit UV exposure by wearing a hat and sunglasses when it is sunny. If the pinguecula becomes inflamed, anti-inflammatory eye drops are sometimes recommended. Sometimes patients ask for a pinguecula to be removed, which can be done by surgery or laser treatment. As this is nearly always a cosmetic procedure, it is rarely undertaken.

Pinguecula
Version 6
Date of search 17.11.17
Date of revision 29.03.18
Date of publication 09.05.18
Date for review 16.11.19
© College of Optometrists

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GROWTHS ON THE EYE

Q. My husband has something growing on the surface of his eye, near his pupil. His eye doctor said that it was benign and that my husband didn’t need to do anything about it unless it started to bother his vision. Can you explain what this condition is? A. It sounds like your husband has what’s called a pterygium (pronounced ter-ij-ee-um). This is a benign growth that usually doesn’t cause any problems. But if it spreads to block his vision, he can have it removed.

The word pterygium comes from a Greek word meaning wing. That’s because a pterygium has a triangular, wing-like shape to it, with a clear to grayish-yellow color. Its base starts in the corner of the eye; the point or apex of the triangle stretches to the cornea, the clear surface over the colored iris and pupil of the eye.

The growths are most likely to occur in people in their twenties and thirties, and they are more common in men. They seem to occur more often in people exposed to a lot of sunlight, wind and dust. The portion over the sclera, the white part of the eye, can pop up over a few months. Growth over the central cornea usually takes years, if it happens at all.

With a pterygium, you may have no symptoms at all. Or, you may have some watery eyes, a gritty sensation, be bothered by bright lights, or have blurred vision.

Often, a pterygium will gradually start to clear up by itself, without any treatment. If so, it may leave a tiny scar on the surface of your eye that’s generally not very noticeable.

If it bothers your vision, you can have it removed by an ophthalmologist. However, these growths can sometimes rapidly recur once they’re removed. And remember, they often go away by themselves. For these reasons, you should have one treated only if it’s bothering you.

Finally, a pterygium is different from another common eye growth, known as a pinguecula (ping-gwek-u-lah, from a Latin word for fat). This benign growth is a tiny amount of fatty material that can appear on either side of the cornea, at the 3 o’clock or 9 o’clock positions. These growths tend to develop in older individuals. They don’t spread to cover the cornea or block vision. No treatment is needed. Evista or Estrogen? Q. In your recent discussion of hormone replacement therapy, you didn’t discuss the new estrogen-like medicine Evista. My doctor put me on this instead of estrogen, saying that it was safer. Is it? A. Evista is a new medicine designed to provide the benefits of estrogen without some of the risks. However, it may not work as well as estrogen for treating or preventing some conditions.

The excitement about raloxifene (brand name Evista) is that it doesn’t seem to raise your risk of cancer of the breast or uterus as much as estrogen. But compared with estrogen, it doesn’t seem to protect you as well from osteoporosis or heart attacks. In fact, Evista is only about half as effective as estrogen in making your bones stronger. And because heart disease is far and away the major cause of death in women, any extra protection that estrogen provides over Evista could make a tremendous difference in lives saved.

However, Evista has some other potential benefits. It doesn’t lead to breast soreness or vaginal bleeding or spotting, as sometimes happens with estrogen. On the other hand, Evista won’t treat the hot flashes that accompany menopause, whereas estrogen will.

Ultimately, we don’t have long-term studies on Evista, so the final answer about its risks and benefits compared with estrogen aren’t yet in. But for women who have a family history of breast cancer, Evista is a good alternative to estrogen. Jay Siwek, a family physician from Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered personally.

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