PINGUECULA

It is a raised yellowish white mass within the bulbar conjunctiva, adjacent to the cornea. It does not tend to grow onto the cornea. However, it may cause cosmetic blemish or irritation if elevated due to inflammation necessary, can easily be removed and will not recur. It is an area of bulbar conjunctival thickening adjoining limbus in the palpebral fissure area . Pinguecula are less transparent than normal conjunctiva and often have a fatty appearance.

They are usually bilateral, triangular, elevated, white to yellow in colour, horizontally oriented.

SYMPTOMS:

Pinguecula are usually asymptomatic.

• Foreign body sensation.
• Watering.
• Burning.
• Itching.
• Mild pain.
• Redness.

CLINICAL FEATURES:

• located in the anterior bulbar conjunctiva adjacent to the limbus. in the inter-palpebral zone, usually more nasally than temporally.
• Usually, there is no corneal involvement. However, there may be punctate epithelial erosions or dellen (thinning of adjacent peripheral part of cornea due to drying).
• Pinguecula are yellowish-white sub-epithelial deposits with possible calcifications.
• Occasionally pinguecula may become inflamed (called pingueculitis) and irritated due to surface drying. The lesion may become highly vascularised and injected.

CAUSE:

Pinguecula are more likely in males, welders and older individuals living in warmer climates. Pinguecula are more common than pterygium.

• Increasing age:
• Ultraviolet light exposure:Chronic sunlight exposure (actinic damage due to both ultraviolet A and B light)
• Gaucher’s disease (inherited lipid storage disease):Pigmented, brown, triangular pinguecula .

DIAGNOSIS:

CLINICAL EXAMINATION.

ELECTRON MICROSCOPY

IMMUNOESSAY.

 COMPLICATIONS 

• Pinguecula can slowly enlarge to become inflamed and irritating (Pingueculitis).

• Restriction of extra-ocular movement.
• Astigmatism.
• Dellen.
• Dysplastic changes and even carcinoma can arise within the epithelium overlying a pinguecula.
• May progress to chronic actinic keratopathy.

Management:

Surgical therapy:

• Simple excision:Chronically inflamed or cosmetically unsatisfactory pingueculae rarely warrant simple excision.
• Laser photocoagulation:Laser photocoagulation may be used to remove pinguecula.

 HOMOEOPATHIC MANAGEMENT:

Argentum nitricum- it is an effective remedy for this condition

Natrum muriaticum- acts as a constitutional remedy in this kind of cases

Zincum metallicum- Pterygium; smarting, lachrymation, itching. tching and soreness of lids and inner angles.  Blurring of one-half of vision;

MERCSOL- Phlyctenul; deep ulcers on corneaExcessive photophobia and acrid lachrymation. Iritis, ordinary or syphilitic, Retinitis albuminuric, ophthalmia neonatorum. Lids śdematous, red, excoriated. Severe burning. Soreness of the eyes.

CANNABIS SAT- patient feels deeply approaching blindness. Misty sight. Pressure from back of eyes, forward. Opacity of cornea.