logging in or signing up ARMA Pterygium drpramod08 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 927 Category: Education License: All Rights Reserved Like it (4) Dislike it (0) Added: May 04, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: drpramod08 (12 month(s) ago) thanks Dear , for that appreciations. Saving..... Post Reply Close Saving..... Edit Comment Close By: curiousiam (12 month(s) ago) Exactly what I hv been longing for,good work! Saving..... Post Reply Close Saving..... Edit Comment Close By: mosabeldeeb (13 month(s) ago) nice ...may i download please? Saving..... Post Reply Close Saving..... Edit Comment Close By: vishalmakwana (16 month(s) ago) very very nice ayurveda aspect. may i download please? Saving..... Post Reply Close Saving..... Edit Comment Close By: magdalene191 (19 month(s) ago) quite an interesting presentation, i especially was looking for the grading which is very well explained. Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Anatomy of conjunctiva : Anatomy of conjunctiva Conjunctiva means (conjoin- To join) joint together Like eyelid to margin and eyeball Dr Pramod Chaudhary M.S.(Ay) Part of conjunctiva : Part of conjunctiva It can be divided in to 3 parts. Palpebral conjunctiva- Bulbar conjunctiva Conjunctival fornix- joint the palpebral and bulbar conjunctiva Dr Pramod Chaudhary M.S.(Ay) Structure of conjunctiva : Structure of conjunctiva It have 3 layers Epithelial 1. marginal conjunctiva have 5layerd 2. tarsal- 2 layerd 3. fornix and bulbar -3 layerd 4. limbal part- 5 layerd 2. Adenoid /lymphoid layers- it is absent I child during birth (3-4month) most developed in fornix part. 3. Fibrous layers-it contains vessels and nerve. Dr Pramod Chaudhary M.S.(Ay) Glands of conjunctiva : Glands of conjunctiva 1.Mucine secretory glands. goblet cells (epithelium) crypts of henle (Tarsal conjunctiva) gland of manz (limbal conjunctiva) these all glands secrete mucine which is essential for wetting the cornea and conjunctiva. Dr Pramod Chaudhary M.S.(Ay) Cont.. : Cont.. 2. Accessory lacrimal gland 1. Gland of krause – present in subconjunctival part of fornix. 2. Gland of wolfring in tarsal plate Dr Pramod Chaudhary M.S.(Ay) Plica semilunaris : Plica semilunaris Pinkish crescentic fold of conjunctiva +nt in medial canthus CRAUNLE small ovoid pinkish mass just medial to plica semilunaris. It is a peice of modified skin it contains sweat gland, sebaceous gland, and hair follicles. Dr Pramod Chaudhary M.S.(Ay) Blood supply : Blood supply Arteries – mainly anterior ciliary artery Veins- anterior ciliary veins Lymphatic drainage – lateral side drain in to periauricular lymph node medial side – submandibular lymph node Dr Pramod Chaudhary M.S.(Ay) Nerve supply : Nerve supply Ciliary nerve- supply the circumcorneal conjunctiva and cornea Rest of conjunctiva is innervated by branches of lacimal nerve, Infratrochlear nerve,supratrochlear, etc. Dr Pramod Chaudhary M.S.(Ay) Slide 9: Dr Pramod Chaudhary M.S.(Ay) ARMA (Pterygium) : ARMA (Pterygium) Arma is described under the heading of suklagata roga in different samhitas ‘Say continuous growing structure’’ Dr Pramod Chaudhary M.S.(Ay) Types of Arma : Types of Arma mÉëxiÉÉËUzÉÑYsɤÉiÉeÉÉÍkÉqÉÉÇxÉ- xlÉÉruÉqÉïxÉÇ¥ÉÉÈ ZÉsÉÑ mÉgcÉ UÉåaÉÉÈ| (xÉÑ. E. 4/2) A/c to sushruta arma is classified into 5types Dr Pramod Chaudhary M.S.(Ay) Slide 12: mÉëxiÉÉËU mÉëÍjÉiÉÍqÉWûÉqÉï zÉÑYsÉpÉÉaÉå ÌuÉxiÉÏhÉïÇ iÉlÉÑ ÂÍkÉUmÉëpÉÇ xÉlÉÏsÉqÉ | zÉÑYsÉÉZrÉÇ qÉ×SÒ MüjÉrÉÎliÉ zÉÑYsÉpÉÉaÉå xɵÉåiÉÇ xÉqÉÍqÉWû uÉ®ïiÉå ÍcÉUåhÉ || rÉlqÉÉÇxÉÇ mÉëcÉrÉqÉÑmÉæÌiÉ zÉÑYsÉpÉÉaÉå mÉ©ÉpÉÇ iÉSÒmÉÌSzÉÎliÉ sÉÉåÌWûiÉÉqÉï || ÌuÉxiÉÏhÉïÇ qÉ×SÒ oÉWûsÉÇ rÉM×üimÉëMüÉzÉÇ zrÉÉuÉÇ uÉÉ iÉSÍkÉMüqÉÉÇxÉeÉÉqÉï ÌuɱÉiÉ | zÉÑYsÉå rÉÎimÉÍzÉiÉqÉÑmÉæÌiÉ uÉ×ήqÉåiÉiÉ xlÉÉruÉqÉåïirÉÍpÉmÉÌPûiÉÇ ZÉUÇ mÉëmÉÉhQÒû || xÉÑ. E. 4/2-4,5,6 Dr Pramod Chaudhary M.S.(Ay) Prastari arma : Prastari arma Viteerna tanu–broad, thin Rudhirprabham- reddish or bluish discoloration. Vagabhata said qÉײÉzÉÑuÉ×SèkrÉÂXûqÉÉÇxÉÇ mÉëxiÉÉËU zrÉÉuÉsÉÉåÌWûiÉqÉ mÉëxiÉÉrÉïqÉï qÉsÉæÈ xÉÉxÉëæÈ || Soft tissue fast grow painless bluish or reddish discoloration vaat and rakt dosa dominance Dr Pramod Chaudhary M.S.(Ay) Shuklarma (Pinguecula) : Shuklarma (Pinguecula) qÉ×S-soft muscular growth, xɵÉåiÉÇ xÉqÉÍqÉWû uÉ®ïiÉå ÍcÉUåhÉ-slight whitish and regular or equal size in each direction, slow growing condition A.H, yogaratnakar ,bhav prakash had same veiw Kaphaj sadhya roga Dr Pramod Chaudhary M.S.(Ay) Lohitarm/¤ÉiÉeÉÉqÉï : Lohitarm/¤ÉiÉeÉÉqÉï Muscular growth in the shuklabhag who is resemble with the colour of kamal puspa. zÉÉåÍhÉiÉÉqÉï xÉqÉÇ zsɤhÉÇ mÉ©ÉpÉqÉÍkÉqÉÉÇxÉMüqÉ || It is Rakataj Sadhya vyadhi Dr Pramod Chaudhary M.S.(Ay) adhimansajarm (Pseudopterygium) : adhimansajarm (Pseudopterygium) ÌuÉxiÉÏhÉïÇ qÉ×SÒ oÉWûsÉÇ rÉM×üimÉëMüÉzÉÇ zrÉÉuÉÇ uÉÉ- broad , soft, resemble the colour of liver (chocolate) some time slight blakish, muscular growth in the shukla bhaga is called adhimansajarma. zÉÑzMüÉxÉ×MüÌmÉhQèuÉcNûrÉÉuÉÇ rÉlqÉÉÇxÉÇ oÉWûsÉÇ mÉ×jÉÑ || (A.H.U 10) Sannipataj sadhya vyadhi Dr Pramod Chaudhary M.S.(Ay) Snayarma : Snayarma xlÉÉruÉqÉåïirÉÍpÉmÉÌPûiÉÇ ZÉUÇ mÉëmÉÉhQÒû- muscular growth in suklabhag who is rough in nature and whitish yellow in colour is called snayarma Tridosaj sadhya roga Dr Pramod Chaudhary M.S.(Ay) Treatments : Treatments If arma in initial stage like prastariarm,suklarm,lohitarm,then use lekhan anjan e.g.chandrodaya varti ,pippalyadi anjana, marichadi lepa,pushyadi raskriya, AqÉïÇcÉÉsmÉÇ SÍkÉÌlÉpÉÇ lÉÏsÉÇ U£üqÉjÉÉÌmÉuÉÉ | kÉÔxÉUÇ iÉlÉÑ rÉŠÉÌmÉ zÉÑYëuɨÉSÒmÉÉcÉUåiÉ || cÉqÉÉïpÉÇ uÉWûsÉÇ rɨÉÑ xlÉÉrÉÑqÉÉÇxÉbÉlÉÉuÉ×iÉqÉ | Nåû±qÉåuÉ iÉSqÉïxrÉÉiÉ M×üwhÉqÉhQèsÉaÉgcÉ rÉiÉ || Dr Pramod Chaudhary M.S.(Ay) Chedan karma : Chedan karma ÎxlÉakÉÇ pÉÑYiuÉiÉÉå ÌWû³ÉqÉÑmÉÌuÉwOèxrÉ rɦÉiÉÈ | xÉÇUÉåmÉrÉå¨ÉÑ lÉrÉlÉÇ ÍpÉwÉMü cÉÔhÉæïxiÉÑ sÉÉuÉhÉæÈ || Snehana Swedana Parighattan (chalan) Badish and muchundi yantra Thread Mandalagra shastra (chedana) 1/4th remains left on the eye ball (avoid complication) Dr Pramod Chaudhary M.S.(Ay) Pterygium : Pterygium Pterygium [(ter-ij-eum) pterygion’wing] Pterygium is a wing shaped fold of conjunctiva encroaching upon the cornea from either side within the interpalpebral fissure , Dr Pramod Chaudhary M.S.(Ay) Etiology : Etiology More common in people working in hot climates. Environmental factor like dry heat, high wind, abundance of dust. Dr Pramod Chaudhary M.S.(Ay) Pathology : Pathology Pterygium is a degenerative and hyperplastic condition of conjunctiva. The subconjunctival tissue undergose elastotic degeneration and proliferates as vascularised granulation tissue under the epithelium. Which ultimately encroaches the cornea. The corneal epithelium, bowman’s layer and superficial stroma are destroyed. Dr Pramod Chaudhary M.S.(Ay) Prevalence : Prevalence Male >female Elderly >child Environmental factor hot and dry climate. Dr Pramod Chaudhary M.S.(Ay) Clinical feature : Clinical feature Triangular fold of conjunctiva encroaching the cornea in the area of palpebral aperture, usually on the nasal side but may also occure in the temporal side. It have 3 parts. Head (apical part present on the cornea) Neck (limbal part) Body (scleral part ) Dr Pramod Chaudhary M.S.(Ay) Slide 25: Progressive pterygium is thick, fleshy and vascular with a few infiltrates in the cornea, in front of the head of pterygium (cap of pterygium) Regressive pterygium is thin atrophic attenuated with very little vascularity. There is no cup. Ultimately it become membranous but never disappears. Dr Pramod Chaudhary M.S.(Ay) Symptoms : Symptoms Asymptomatic in early stage Cosmetic intolerance Visual disturbances (Pupillary reason involved) Occasionally diplopia Grittiness Foreign body sensation Dr Pramod Chaudhary M.S.(Ay) Differential diagnosis : Differential diagnosis Pterygium must be differentiated from pseudopterygium and some time pinguecula. Pseudopterygium is a fold of bulber conjunctiva attached to the cornea. It is formed due to adhesions of chemosed bulbar conjunctiva to the mrginal corneal ulcer. Dr Pramod Chaudhary M.S.(Ay) Stages of pterygium : Stages of pterygium Grade I-it extend <2mm on to the cornea a deposit of Iron (stocker line) may be seen in the corneal epithelium anterior to the head of pterygium. Grade II- involve up to 4mm of the cornea. They may interfere with the precorneal tear film, and induce astigmatism. Grade III- invade >4mm of the cornea and involve the visual axis. Dr Pramod Chaudhary M.S.(Ay) Grade I : Grade I horizontal diameter of cornea is 11.7mm Vertical diameter is 11mm Dr Pramod Chaudhary M.S.(Ay) Grade II : Grade II Arrow show the distance from corneal margin to the head Dr Pramod Chaudhary M.S.(Ay) Grade III : Grade III Length of arrow is >4mm Dr Pramod Chaudhary M.S.(Ay) differentiation : differentiation Pterygium Degenerative process Usually occurs in elderly persons. Always situated in the palpebral aperture. Either progressive, regressive or stationary Probe can not be passed underneath. Pseudopterygium Inflammatory process Can occurs at any age. Can occurs at any sites. Always stationary. A probe can be passed underneath. Dr Pramod Chaudhary M.S.(Ay) Slide 33: Pterygium Pseudopterygium Dr Pramod Chaudhary M.S.(Ay) Pingue cula : Pingue cula It is extremely common degenerative condition of conjunctiva It is characterized by formation of a yellowish white patch on the bulbar conjunctiva near limbus (It resemble to fat which means Pinguis) Dr Pramod Chaudhary M.S.(Ay) Treatment : Treatment Medical treatments- 1. Symptomatic like tear substitute, topical steroids for inflammation, should be advised to wear sunglass to reduce UV exposure and decrease the growth stimulus(Nidan Parivarjana) Surgical excision indicated for Cosmetic reasions Continued progression threatening to encroach onto the pupillary area. Diplopia due to the interference in ocular movement. Dr Pramod Chaudhary M.S.(Ay) Slide 36: Recurrence of the pterygium after surgical excision is the main problem(30%-50%) It can be reduced by any of the following measures. Transplantation of pterygium in the lower fornix(McReynold’s operation) Postoperative Beta irradiation Postoperative use of antimitotic drugs such as mytomycine-c or thiotepa. Surgical excision with mucous membrane grafts. Dr Pramod Chaudhary M.S.(Ay) Slide 37: Dr Pramod Chaudhary M.S.(Ay) Slide 38: Dr Pramod Chaudhary M.S.(Ay) You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
ARMA Pterygium drpramod08 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 927 Category: Education License: All Rights Reserved Like it (4) Dislike it (0) Added: May 04, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: drpramod08 (12 month(s) ago) thanks Dear , for that appreciations. Saving..... Post Reply Close Saving..... Edit Comment Close By: curiousiam (12 month(s) ago) Exactly what I hv been longing for,good work! Saving..... Post Reply Close Saving..... Edit Comment Close By: mosabeldeeb (13 month(s) ago) nice ...may i download please? Saving..... Post Reply Close Saving..... Edit Comment Close By: vishalmakwana (16 month(s) ago) very very nice ayurveda aspect. may i download please? Saving..... Post Reply Close Saving..... Edit Comment Close By: magdalene191 (19 month(s) ago) quite an interesting presentation, i especially was looking for the grading which is very well explained. Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Anatomy of conjunctiva : Anatomy of conjunctiva Conjunctiva means (conjoin- To join) joint together Like eyelid to margin and eyeball Dr Pramod Chaudhary M.S.(Ay) Part of conjunctiva : Part of conjunctiva It can be divided in to 3 parts. Palpebral conjunctiva- Bulbar conjunctiva Conjunctival fornix- joint the palpebral and bulbar conjunctiva Dr Pramod Chaudhary M.S.(Ay) Structure of conjunctiva : Structure of conjunctiva It have 3 layers Epithelial 1. marginal conjunctiva have 5layerd 2. tarsal- 2 layerd 3. fornix and bulbar -3 layerd 4. limbal part- 5 layerd 2. Adenoid /lymphoid layers- it is absent I child during birth (3-4month) most developed in fornix part. 3. Fibrous layers-it contains vessels and nerve. Dr Pramod Chaudhary M.S.(Ay) Glands of conjunctiva : Glands of conjunctiva 1.Mucine secretory glands. goblet cells (epithelium) crypts of henle (Tarsal conjunctiva) gland of manz (limbal conjunctiva) these all glands secrete mucine which is essential for wetting the cornea and conjunctiva. Dr Pramod Chaudhary M.S.(Ay) Cont.. : Cont.. 2. Accessory lacrimal gland 1. Gland of krause – present in subconjunctival part of fornix. 2. Gland of wolfring in tarsal plate Dr Pramod Chaudhary M.S.(Ay) Plica semilunaris : Plica semilunaris Pinkish crescentic fold of conjunctiva +nt in medial canthus CRAUNLE small ovoid pinkish mass just medial to plica semilunaris. It is a peice of modified skin it contains sweat gland, sebaceous gland, and hair follicles. Dr Pramod Chaudhary M.S.(Ay) Blood supply : Blood supply Arteries – mainly anterior ciliary artery Veins- anterior ciliary veins Lymphatic drainage – lateral side drain in to periauricular lymph node medial side – submandibular lymph node Dr Pramod Chaudhary M.S.(Ay) Nerve supply : Nerve supply Ciliary nerve- supply the circumcorneal conjunctiva and cornea Rest of conjunctiva is innervated by branches of lacimal nerve, Infratrochlear nerve,supratrochlear, etc. Dr Pramod Chaudhary M.S.(Ay) Slide 9: Dr Pramod Chaudhary M.S.(Ay) ARMA (Pterygium) : ARMA (Pterygium) Arma is described under the heading of suklagata roga in different samhitas ‘Say continuous growing structure’’ Dr Pramod Chaudhary M.S.(Ay) Types of Arma : Types of Arma mÉëxiÉÉËUzÉÑYsɤÉiÉeÉÉÍkÉqÉÉÇxÉ- xlÉÉruÉqÉïxÉÇ¥ÉÉÈ ZÉsÉÑ mÉgcÉ UÉåaÉÉÈ| (xÉÑ. E. 4/2) A/c to sushruta arma is classified into 5types Dr Pramod Chaudhary M.S.(Ay) Slide 12: mÉëxiÉÉËU mÉëÍjÉiÉÍqÉWûÉqÉï zÉÑYsÉpÉÉaÉå ÌuÉxiÉÏhÉïÇ iÉlÉÑ ÂÍkÉUmÉëpÉÇ xÉlÉÏsÉqÉ | zÉÑYsÉÉZrÉÇ qÉ×SÒ MüjÉrÉÎliÉ zÉÑYsÉpÉÉaÉå xɵÉåiÉÇ xÉqÉÍqÉWû uÉ®ïiÉå ÍcÉUåhÉ || rÉlqÉÉÇxÉÇ mÉëcÉrÉqÉÑmÉæÌiÉ zÉÑYsÉpÉÉaÉå mÉ©ÉpÉÇ iÉSÒmÉÌSzÉÎliÉ sÉÉåÌWûiÉÉqÉï || ÌuÉxiÉÏhÉïÇ qÉ×SÒ oÉWûsÉÇ rÉM×üimÉëMüÉzÉÇ zrÉÉuÉÇ uÉÉ iÉSÍkÉMüqÉÉÇxÉeÉÉqÉï ÌuɱÉiÉ | zÉÑYsÉå rÉÎimÉÍzÉiÉqÉÑmÉæÌiÉ uÉ×ήqÉåiÉiÉ xlÉÉruÉqÉåïirÉÍpÉmÉÌPûiÉÇ ZÉUÇ mÉëmÉÉhQÒû || xÉÑ. E. 4/2-4,5,6 Dr Pramod Chaudhary M.S.(Ay) Prastari arma : Prastari arma Viteerna tanu–broad, thin Rudhirprabham- reddish or bluish discoloration. Vagabhata said qÉײÉzÉÑuÉ×SèkrÉÂXûqÉÉÇxÉÇ mÉëxiÉÉËU zrÉÉuÉsÉÉåÌWûiÉqÉ mÉëxiÉÉrÉïqÉï qÉsÉæÈ xÉÉxÉëæÈ || Soft tissue fast grow painless bluish or reddish discoloration vaat and rakt dosa dominance Dr Pramod Chaudhary M.S.(Ay) Shuklarma (Pinguecula) : Shuklarma (Pinguecula) qÉ×S-soft muscular growth, xɵÉåiÉÇ xÉqÉÍqÉWû uÉ®ïiÉå ÍcÉUåhÉ-slight whitish and regular or equal size in each direction, slow growing condition A.H, yogaratnakar ,bhav prakash had same veiw Kaphaj sadhya roga Dr Pramod Chaudhary M.S.(Ay) Lohitarm/¤ÉiÉeÉÉqÉï : Lohitarm/¤ÉiÉeÉÉqÉï Muscular growth in the shuklabhag who is resemble with the colour of kamal puspa. zÉÉåÍhÉiÉÉqÉï xÉqÉÇ zsɤhÉÇ mÉ©ÉpÉqÉÍkÉqÉÉÇxÉMüqÉ || It is Rakataj Sadhya vyadhi Dr Pramod Chaudhary M.S.(Ay) adhimansajarm (Pseudopterygium) : adhimansajarm (Pseudopterygium) ÌuÉxiÉÏhÉïÇ qÉ×SÒ oÉWûsÉÇ rÉM×üimÉëMüÉzÉÇ zrÉÉuÉÇ uÉÉ- broad , soft, resemble the colour of liver (chocolate) some time slight blakish, muscular growth in the shukla bhaga is called adhimansajarma. zÉÑzMüÉxÉ×MüÌmÉhQèuÉcNûrÉÉuÉÇ rÉlqÉÉÇxÉÇ oÉWûsÉÇ mÉ×jÉÑ || (A.H.U 10) Sannipataj sadhya vyadhi Dr Pramod Chaudhary M.S.(Ay) Snayarma : Snayarma xlÉÉruÉqÉåïirÉÍpÉmÉÌPûiÉÇ ZÉUÇ mÉëmÉÉhQÒû- muscular growth in suklabhag who is rough in nature and whitish yellow in colour is called snayarma Tridosaj sadhya roga Dr Pramod Chaudhary M.S.(Ay) Treatments : Treatments If arma in initial stage like prastariarm,suklarm,lohitarm,then use lekhan anjan e.g.chandrodaya varti ,pippalyadi anjana, marichadi lepa,pushyadi raskriya, AqÉïÇcÉÉsmÉÇ SÍkÉÌlÉpÉÇ lÉÏsÉÇ U£üqÉjÉÉÌmÉuÉÉ | kÉÔxÉUÇ iÉlÉÑ rÉŠÉÌmÉ zÉÑYëuɨÉSÒmÉÉcÉUåiÉ || cÉqÉÉïpÉÇ uÉWûsÉÇ rɨÉÑ xlÉÉrÉÑqÉÉÇxÉbÉlÉÉuÉ×iÉqÉ | Nåû±qÉåuÉ iÉSqÉïxrÉÉiÉ M×üwhÉqÉhQèsÉaÉgcÉ rÉiÉ || Dr Pramod Chaudhary M.S.(Ay) Chedan karma : Chedan karma ÎxlÉakÉÇ pÉÑYiuÉiÉÉå ÌWû³ÉqÉÑmÉÌuÉwOèxrÉ rɦÉiÉÈ | xÉÇUÉåmÉrÉå¨ÉÑ lÉrÉlÉÇ ÍpÉwÉMü cÉÔhÉæïxiÉÑ sÉÉuÉhÉæÈ || Snehana Swedana Parighattan (chalan) Badish and muchundi yantra Thread Mandalagra shastra (chedana) 1/4th remains left on the eye ball (avoid complication) Dr Pramod Chaudhary M.S.(Ay) Pterygium : Pterygium Pterygium [(ter-ij-eum) pterygion’wing] Pterygium is a wing shaped fold of conjunctiva encroaching upon the cornea from either side within the interpalpebral fissure , Dr Pramod Chaudhary M.S.(Ay) Etiology : Etiology More common in people working in hot climates. Environmental factor like dry heat, high wind, abundance of dust. Dr Pramod Chaudhary M.S.(Ay) Pathology : Pathology Pterygium is a degenerative and hyperplastic condition of conjunctiva. The subconjunctival tissue undergose elastotic degeneration and proliferates as vascularised granulation tissue under the epithelium. Which ultimately encroaches the cornea. The corneal epithelium, bowman’s layer and superficial stroma are destroyed. Dr Pramod Chaudhary M.S.(Ay) Prevalence : Prevalence Male >female Elderly >child Environmental factor hot and dry climate. Dr Pramod Chaudhary M.S.(Ay) Clinical feature : Clinical feature Triangular fold of conjunctiva encroaching the cornea in the area of palpebral aperture, usually on the nasal side but may also occure in the temporal side. It have 3 parts. Head (apical part present on the cornea) Neck (limbal part) Body (scleral part ) Dr Pramod Chaudhary M.S.(Ay) Slide 25: Progressive pterygium is thick, fleshy and vascular with a few infiltrates in the cornea, in front of the head of pterygium (cap of pterygium) Regressive pterygium is thin atrophic attenuated with very little vascularity. There is no cup. Ultimately it become membranous but never disappears. Dr Pramod Chaudhary M.S.(Ay) Symptoms : Symptoms Asymptomatic in early stage Cosmetic intolerance Visual disturbances (Pupillary reason involved) Occasionally diplopia Grittiness Foreign body sensation Dr Pramod Chaudhary M.S.(Ay) Differential diagnosis : Differential diagnosis Pterygium must be differentiated from pseudopterygium and some time pinguecula. Pseudopterygium is a fold of bulber conjunctiva attached to the cornea. It is formed due to adhesions of chemosed bulbar conjunctiva to the mrginal corneal ulcer. Dr Pramod Chaudhary M.S.(Ay) Stages of pterygium : Stages of pterygium Grade I-it extend <2mm on to the cornea a deposit of Iron (stocker line) may be seen in the corneal epithelium anterior to the head of pterygium. Grade II- involve up to 4mm of the cornea. They may interfere with the precorneal tear film, and induce astigmatism. Grade III- invade >4mm of the cornea and involve the visual axis. Dr Pramod Chaudhary M.S.(Ay) Grade I : Grade I horizontal diameter of cornea is 11.7mm Vertical diameter is 11mm Dr Pramod Chaudhary M.S.(Ay) Grade II : Grade II Arrow show the distance from corneal margin to the head Dr Pramod Chaudhary M.S.(Ay) Grade III : Grade III Length of arrow is >4mm Dr Pramod Chaudhary M.S.(Ay) differentiation : differentiation Pterygium Degenerative process Usually occurs in elderly persons. Always situated in the palpebral aperture. Either progressive, regressive or stationary Probe can not be passed underneath. Pseudopterygium Inflammatory process Can occurs at any age. Can occurs at any sites. Always stationary. A probe can be passed underneath. Dr Pramod Chaudhary M.S.(Ay) Slide 33: Pterygium Pseudopterygium Dr Pramod Chaudhary M.S.(Ay) Pingue cula : Pingue cula It is extremely common degenerative condition of conjunctiva It is characterized by formation of a yellowish white patch on the bulbar conjunctiva near limbus (It resemble to fat which means Pinguis) Dr Pramod Chaudhary M.S.(Ay) Treatment : Treatment Medical treatments- 1. Symptomatic like tear substitute, topical steroids for inflammation, should be advised to wear sunglass to reduce UV exposure and decrease the growth stimulus(Nidan Parivarjana) Surgical excision indicated for Cosmetic reasions Continued progression threatening to encroach onto the pupillary area. Diplopia due to the interference in ocular movement. Dr Pramod Chaudhary M.S.(Ay) Slide 36: Recurrence of the pterygium after surgical excision is the main problem(30%-50%) It can be reduced by any of the following measures. Transplantation of pterygium in the lower fornix(McReynold’s operation) Postoperative Beta irradiation Postoperative use of antimitotic drugs such as mytomycine-c or thiotepa. Surgical excision with mucous membrane grafts. Dr Pramod Chaudhary M.S.(Ay) Slide 37: Dr Pramod Chaudhary M.S.(Ay) Slide 38: Dr Pramod Chaudhary M.S.(Ay)