Pinguecula
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
Degenerative conjunctival lesion, usually situated nasally at the limbus
Degeneration of collagen fibres of the conjunctival stroma
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
Male gender (likely to be related to occupational exposure)
Chronic irritation from wind or dust
Contact lens wear
Usually asymptomatic
Possible mild foreign body sensation and redness when inflamed
Occasional cosmetic concern
Area of conjunctival thickening adjoining the limbus
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
Pterygium
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
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
Reassure patient about benign nature of the lesion (no threat to health or sight)
Advise on UV protection to minimise risk of inflammation
Cold compresses when inflamed
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
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)
B2: alleviation / palliation: normally no referral
Excision is very rarely warranted
A single case series has described effective cosmetic removed of pingueculae by argon laser photocoagulation
*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
Mimura T, Usui T, Mori M, Yamamoto H, Obata H, Yamagami S, Funatsu H, Noma H, Honda N, Amano S. Pinguecula and contact lenses. Eye (Lond). 2010;24(11):1685-91
Oguz H, Karadede S, Bitiren M, Gurler B, Cakmak M. Tear functions in patients with pinguecula. Acta Ophthalmol Scand. 2001;79(3):262-5
Viso E, Gude F, Rodríguez-Ares MT. Prevalence of pinguecula and pterygium in a general population in Spain. Eye (Lond). 2011;25(3):350-7
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
View more Clinical Management Guidelines