Most people have never heard the word pterygium, but many have seen it: a pinkish, fleshy growth creeping across the white of someone's eye, sometimes onto the coloured part itself. Known colloquially in Australia as surfer's eye, it's one of the most common reasons people are referred to a corneal specialist, and one of the most misunderstood. Sydney-based corneal and refractive surgeon Dr Tanya Trinh explains what causes it, who is most at risk and why treating it well is harder than it appears.
What is pterygium?
Pterygium is a growth of fleshy tissue that develops on the surface of the eye and can extend across the cornea, the clear window at the front through which light enters. Dr Trinh describes it as the eye attempting to grow its own protective layer of skin. Left to progress, it can pull on the surface of the eye, distorting its shape and, in more advanced cases, physically blocking the line of sight.
Sun exposure is the main driver
The name "surfer's eye" reflects who is most commonly affected, but the underlying cause is cumulative ultraviolet exposure rather than surfing specifically. Dr Trinh sees the same pattern in construction workers, roofers and landscapers, and in anyone who grew up in a sun-heavy environment before sun-safety awareness became widespread in Australia. Globally, pterygium is most common in the band between the tropics of Cancer and Capricorn, and Dr Trinh notes a significant number of her patients come from the Philippines and Indonesia, where high UV exposure is often compounded by heat, arid conditions and higher pollution levels.
Symptoms go beyond appearance
While pterygium is often first noticed as a cosmetic concern, its effects can be functional. Dr Trinh explains that as the growth pulls on the ocular surface, it can cause astigmatism and blurred vision. It also commonly causes a persistent foreign-body sensation and chronic dryness, and can make contact lens wear difficult or impossible in more advanced cases.
Growth is unpredictable, which affects timing of treatment
Pterygium does tend to stop growing at some point, but there is no reliable way to predict when or where. This uncertainty shapes how Dr Trinh approaches treatment. If a pterygium is allowed to grow across the central cornea before it's removed, it leaves a permanent shadow on vision, even after successful surgery, because the underlying corneal tissue has already been affected. For that reason, her preference is to operate while a pterygium is still small enough to treat safely, rather than waiting for it to threaten central vision.
When to get it checked
In Australia, optometrists are usually the first point of contact and are well equipped to identify a pterygium during a routine eye test. Dr Trinh recommends having any new growth on the surface of the eye assessed rather than waiting to see if it worsens, since early monitoring gives the best chance of treating it while it's still small. If a pterygium is growing, affecting vision or causing persistent irritation, an optometrist will typically refer on to an ophthalmologist for further assessment and, if needed, surgery.
Why surgery is often more complex than it looks
Pterygium surgery has a reputation problem: it sounds like a minor procedure, but it's technically demanding, largely because recurrence has historically been a major issue. Published literature places recurrence rates for standard pterygium excision using a conjunctival graft at between 5 and 15 percent, and considerably higher again for excision without any grafting at all.
Dr Trinh's own practice uses a specific technique called P.E.R.F.E.C.T. for Pterygium, developed over more than two decades by Professor Lawrence Hirst, one of the most published researchers in the field internationally. The technique involves widely removing the pterygium tissue and covering the area with an extended graft of the patient's own conjunctiva, carefully hand-stitched into place. Hirst's own published case series has reported recurrence rates below one percent, a marked improvement on conventional approaches, and Dr Trinh is one of a small number of surgeons worldwide accredited in the technique.
Protecting your eyes going forward
Pterygium can't always be prevented, particularly for those with a lifetime of outdoor sun exposure already behind them, but ongoing risk can be meaningfully reduced. Dr Trinh's advice is consistent with general UV protection: broad-brimmed hats, wraparound sunglasses and avoiding unprotected exposure during peak UV hours. For those who already have a pterygium, regular monitoring means it can be treated at the right time, before it has a chance to permanently affect vision.
Source: Interview with Dr Tanya Trinh, conducted by Prof Hosen Kiat for the TAIK Health Community.
Dr Tanya Trinh, co-director of Australia's only Keratoprosthesis Service at Sydney Eye Hospital and founder of LUMIÈRE Vision, is a Clinical Collaborator with the TAIK Health Community.
