Optometrists Find High Incidence of Eye Growths and Bumps on White of Eyes in Northern Colorado are Benign & Often Pinguecula
A large number of people in the Fort Collins show up at the optometrists office with benign growths on the white part of their eye referred to as pingueculas. Actually they develop on the conjunctiva, the clear tissue that covers the white part of the eye (the sclera). Often they appear as mildly elevated yellowish bumps, visible to the patient or a family member with a urgent rush to the eye doctor. Often people are reluctant to discuss their concerns hoping it will be found during an eye exam. You should not hesitate to mention this at the beginning of you visit to the optometrists office. Because they are so common, you eye doctor may not mention the presence of a pinguecula on your eye unless you ask. While most optometrists find pingueculas developing in patients eyes who are over the age of 40, it is becoming more common to see them by the mid twenties. They are presumed to be caused by a UV radiation from the sun and low level irritants like dust and small particles in the wind. The incidence increases closer to the equator. Fort Collins East of I-25 they are extremely common due to the farming industry with people spending larger amounts of time outdoors and in dusty environments. People who spend their leisure time on motorcycles are also more at risk due to the ultraviolet exposure and particles from the blowing wind.
What Causes Eye Growths of Pingucula
Just as skin loses is capacity to stretch with age, so does the conjunctival tissue when it is exposed to sunlight and irritation over a cumulative period of years. In Northern Colorado people frequently visit doctors for skin changes that are essentially occurring from the the same as the eye conjuntival changes.
Eye Doctors have found the elastosis, or the capacity of the tissue to smoothly stretch and return to normal is compromised from changes to the conjunctival tissue. Collagen forms the framework, but elastin protein fibers around the collagen fibers provide the stretching capacity. The UV radiation in Fort Collins is higher due to the altitude, reflections from snow, and the amount of time we spend outdoors. With close to 300 days a year of sunshine the UV exposure is higher than most areas at a similar latitude. Altitude increases the UV dosage by 4-5% /1000 feet of elevation gain. Compared to sea level this adds approximately 25% above sea level exposures.
First there is an accumulation of abnormal cells that are altered elastin and / or collagen. Eventually the area starts to lose cells and becomes more of a deposit of protein materials often referred to as hyaline deposits. Calcification can occur over time also. Several theories have been proposed by eye research clinics for the changes seen in the tissues that form the pinguecula. This UV radiation and low level chronic irritation causes changes that may be:
- An increase in the production of elastin fibers by the fibroblast cells and changes to the elastin nature into a more twisted form as they replace some of the collagen fibers. This may induce degenerative changes to the collagen fibers.
- A interference with the natural cycle of cell programmed cell death of elastin resulting in an overproduction that takes on the abnormalities.
- A degradation of the collagen fibers into a compromised form resembling elastin.
- A combination of the above
Other factors may make the conjunctival tissue more susceptible to forming pinguecula.
- Since the conjunctiva tissue does not have the tough keratin layer like the skin it is damaged faster by UV radiation.
- The clear conjunctiva tissue is also transparent and the solar radiation that is not absorbed passes through to the sclera. We know from science that color of the surface being irradiated has a large bearing on the amount of back reflected radiation including UV. It is a very thin tissue, and the white scleral tissue underneath it with it’s white coloration should have an albedo in the range of 80-90% similar to the reflectance of snow. Measured animal studies of conjunctival tissue reflectivity across the 440 to 1000+nm range shows a steady reflectance of above 40%. Somewhere between 40 to 80 percent of the UV radiation is being added to the initial dose as it passes through. This extra back reflection of UV into the conjunctiva tissue also increases the exposure and ages the tissue faster than skin.
- Eye conditions that increase the size of the fissure, or how wide your eye stays open, also will increase the incidence of pinguecula. Thyroid eye disease and eyes that are not as deeply recessed (the beady eyed individual with a protruding eyebrow to shadow the eye) or more likely to develop pinguecula. Studies have shown an increase in pinguecula in patients with Thyroid Orbitopathy (hyperthyroid or an overactive thyroid gland that effects the eye) that is only significant with the widened eye fissure or amount of the eye normally exposed when open). Increased dry eyes was not correlated further suggesting UV exposure as a causative factor. 
- The nose acts to reflect more light onto the eye somewhat like a dull mirror, and pinguecula are more commonly found on the white side closest to the eyes, but they are also found on the temporal side.
- The deeper, or basal layers of the superior nasal conjunctival tissue contain more dendritic cells. Dendritic cells are a type of antigen-presenting cell (APC). Antigens are molecules or molecular fragments that bind to a site on on the surface of cells, and except for autoimmune diseases they are the molecules from outside the body. Dendritic cells present them to the T helper cells that increase the immune response and that cause an increase in inflammatory cells. The tears flow towards the nose by slight eyelid horizontal movements that accompany each blink. This ensures a continuous flushing of debris and antigens from the tear film, Since the tears flow in this direction logically their would be more dendritic cells to help remove the excess antigens. Due to the density of the dendritic cells and the propensity to create more inflammation, it has been postulated this may increase the overall likelihood of pinguecula forming in the nasal region.
- Psoralen plus ultraviolet A (PUVA) treatment has been used widely in the past for various dermatoligic conditions. It has seen a reduction in use due to other methods. PUVA uses a photosensitizing agent (8-methoxypsoralen, Oxsoralen®) taken orally or applied to the effected area before exposure to ultraviolet A light (320-400 nm). At least one case of pinguecula associated with PUVA has been reported. (the patient was in poor in compliance with eye protection)
Pinguecula Are Always Benign Growths
Once a Pingueclua has been properly diagnosed by your optometrist you can rest assured. Pinguecula are always benign growths and never develop into any form of eye cancer. They can start to grow across the clear cornea tissue on the front of the eye at which point they are referred to as pterygium. Pterygium need to be followed as they need to be removed by an eye surgeon if they approach to close to the line of sight. While the surgical removal is fairly simple, they tend to recur and leave a scar. That leaves a wait and follow choice by your eye doctor. Because they are so slow to develop it is fairly easy to manage. New technology is reducing the recurrence, but remember, the majority of pingueculas don’t develop into pterygiums. In our Fort Collins Eye Clinic we occasionally see patients with symptoms related to pinguecula.
Pinguecula Symptoms and Signs
The elevation may disrupt the normal tear resurfacing on the eye and create an area of dryness and discomfort. It can also result in the edges of soft contact lenses settling poorly on the eye and leaving a gap between the soft contact lens and the conjunctiva. This often results in the lens drying out and the peripheral contact lens edge curling away from the conjunctiva. Contact lens patients will blink and subsequently the eyelid movement can eject the contact lens. Rigid gas permeable lenses may leave a gap over the conjunctiva and edges of the cornea that dies out and damages the peripheral cornea epithelium surface cells and the conjunctival cells. The edge of the gas permeable lens may also irritate the pinguecula and result in a chronic red eye when contact lenses are worn. This can often be resolved by changing the diameter or size of the gas permeable contact lens. A test used in research facilities called “tear ferning” evaluates the mucous layer of tears by allowing a sample to dry on a slide and crystallize. This is often abnormal around pinguecula indicating a mucous irregularity inducing dry eyes. Occasionally pinguecula become inflamed and need prescription eyedrops to restore comfort. The incidence of problems is low and treatable so eye doctors almost never remove a pinguecula.
Optometrists Prevetative Steps For Pinguecula
UV prescription eyeglasses (or non prescription quality sunwear) is the most important preventive step you can take. Not only will it help prevent pinguecula, but also a number of other eye diseases associated with sunlight exposure. Do a favor for your children and teenagers eye health, start them in prescription sunglasses (transition lenses that lighten and darken also offer UV protection). When you think of sunscreen think of sunscreen for the eyes. The more time you spend in the sun, the more you should think of sunwear that wraps around your face and protects the sides. Up to 40% of the UV exposure can still enter from the unprotected side of a normal pair of eye glasses. Special motorcycle eyeglass frames have become very popular in our Ft Collins Eye Care Center due to the side protection from UV and wind & dust. Wearing a hat with a brow helps reduce UV exposure. Limiting midday sun exposure is very useful when possible. The morning and afternoon sun is lower on the horizon and has a much longer path to travel through the atmosphere which filters out more UV. Don’t avoid the sun totally. While there is much controversy at this point, it does appear that some sun exposure is good for your health, reducing some forms of cancer and possibly decreasing the incidence of multiple sclerosis. While vitamin D may be the protective factor some studies indicate their may be other factors and biochemical involved. Keep your eyes posted for more eye updates as we learn more about the fascinating world of vision!
References http://geography.about.com/od/physicalgeography/a/solarradiation.htm [2} http://www3.interscience.wiley.com/journal/112130369/abstract?CRETRY=1&SRETRY=0  Hoang-Xuan,Thanh; Baudouin, Christophe Inflammatory Diseases of the Conjunctiva, Catherine Creuzot-Garcher  Journal of the American Academy of Dermatology
Volume 57, Issue 1, Pages 177-178 (July 2007)
Pinguecula following psoralen and ultraviolet A therapy
Amit Garg, Michael Loosemore, BAb  Cornea:
June 2010 – Volume 29 – Issue 6 – pp 659-663
Prevalence of Pinguecula and Pterygium in Patients With Thyroid Orbitopathy
Ozer, Pnar Altiaylik MD; Altiparmak, Ugur E MD; Yalniz, Zuleyha MD; Kasim, Remzi MD; Duman, Sunay MD
Doctor I think I might have this pinguecula eye growth and iam hoping
Where I can get good genuine glasses from.
John, age 39,from Papua new guinea.
You really need a frame that offers some protection on the sides, usually larger side arms can do the trick. These type of frames are fairly popular today, especially in Europe. If it fits closer to your face it will also block more of the UV and wind. Anything like a Wiley-X frame or similar wrap around frame will do the trick. A brown transition lens that lightens inside and darkens in the sun is also great. Transitions is the brand of lens and is available pretty much anywhere. There is a clinic in Port Moresby, Papua New Guinea associated with Optometry Giving Sight. I don’t know what they have available but you might want to check them out if you are in a remote area and/or costs are a concern. Optometry Giving Sight is a wonderful organization with a great concept. They don’t want to wander in places, provide some services, then leave with no follow-up care. Their mission is to build permanent facilities with local people involved in an ongoing clinic. Otherwise, head to the biggest close city and I’m sure they can help you.
I have had dry eyes for many years and had corrective surgery (PRK) in 2004. In 2008 I noticed my eyes were very dry and very red. In 2010 my eye doctor said I had a Pinguecula in one eye. It is always very red and inflamed and looks so horrible. Is their anything I can do to stop this inflammation? I currently use Maxivision dry eye fish oil vitamins, I drink nothing but water, I am not on any medications, I use a humidifier in my office and home. I’ve tried everything to treat the dry eyes. (including restasis) I feel like the more dry my eyes the worse the blood vessels are around my pingecula. Thanks so much for your time.
I find chronic red eyes that are from associated with pinguecula (and in general chronically red eyes that are not from infections) to be one of the most challenging areas to treat. When the red eye is associated with a pinguecula that periodically becomes red (more than normal) and irritated, it is referred to as pingueculitis. Adding that “itis” makes it sound like we actually know something which is not the case!
If you suffer from these periodic flareups, steroid eye drops are the normal treatment. Steroid eye drops can have numerous side effects so I don’t like to leave people on them long term or use them too often. They can cause cataracts and glaucoma. The newer “designer steroids” are much safer but also much more expensive. Lotemax is the prescription steroid eye drop that falls in this category. Usually it takes at least a few weeks for problems to occur, so I adhere to a simple rule- steroids are OK for most people for a couple of weeks a couple of times per year. They are pretty safe when used that way, and can provide lots of relief. Lotemax is preferable, but I tend to use other drops quite frequently since it is hard to get insurance coverage for this eye medication.
Dry eyes often accompany pinguecula and can cause redness or aggravate it. I almost always use a short pulse of steroid drops for a few weeks in dry eye patients. It hits two birds with one stone; the inflammation is reduced which also helps treat dry eye syndrome. Another cause for periodic eye redness is episcleritis which is also another condition we know very little about. It causes an acute onset of redness in a secotor of the white area with a prickly, almost itchy type of feeling. Oddly enough, steroids are also very successful in treating this making your eye doc appear to know way more than he or she does.
Some people just seem to have chronic redness. In your case you are noticing dryness. It is probably safe to assume that you have a dry eye that is causing part or all of your problem. The pinguecula probably make it worse by interfering with the tear film resurfacing that ocurrs when you blink. Refractive surgery also tends to create dry eye problems although more so with LASIK than PRK.
If you have not tried a pulse of steroid drops you should ask your eye doc about that. They can really knock down the inflammation in a hurry, and help most patients (though not everyone). Maxivision is a good product, but not one I use. Talk to you eye doctor about the dosage. Frequently I see patients taking 1000 or 2000 mg. I think 3000 mg of combine DHA & EPA is a better dose for dry eyes. You have to read the label since 1000 mg capsules often contain much less EPA & DHA combined. While there is no real research to substantiate it, I prefer the triglyceride form of Omega-3 supplements. Carlsons and Nordic are two that fall in that category. It takes 6-8 weeks to know how you are going to respond so don’t stop after a month or so. Same way with Restasis only it can take up to 6 months. So many people try it and are not told how slow the onset is. Restasis is a very safe drop that has anti-inflammatory properties. There is really very little concern (other than cost) about taking it for the long term. Cold washcloths or cool packs can help reduce inflammation. You can also try chilling non preserved artificial tears in the refrigerator.
Tear plugs help some people but in my experience they have a limited reach in solving your type of problem. There are other options but I would recommend seeing your eye doctor again and trying a steroid drop for 3 weeks, increasing the amount of Omega-3 if you are not at an optimal dosage, and using cool packs and artificial tears. Give it 2-3 months.
Last but not least, avoid the get the res out type of eyedrops. For a fair number of people they just make things worse after an initial period of relief. I still find people who have red eyes from the very drops they are suing to get rid of the red- so they use more-and you can see where that is going!
Thanks so much for the information. I have been to multiple eye doctors since 2008. They first did the film test to see how fast my tears evaporate and determined I had severe dry eyes. He told me to do cold compress and artificial tears frequently. I did that for a while and found the artificial tears make my eyes feel very irritated and more dry. I then seen a specialist whom told me about the pinguecula and he put me on Lotemax and restasis together. I do not have eye insurance so that was very costly , but I did it. I however after 6 months gave up cause the restasis burned and in turn made my eyes more red. And it was draining my bank account, haha. I then seen another specialist in 2012 that put in punctal plugs and referred me to a hospital that would draw my blood, and spin all the red cells out and keep the white to make eyedrops using my own dna. I tried that for 2 months and while the drops felt good, it was the same effect after a half hour or so that they felt that much more dry and I wanted to put the drops in every 15 minutes. I have researched this online for years and have yet to find anything. The redness and dryness is just awful. It has really effected my quality in life. Its hard to look people in the eye so I often look down. I just wish I could find something. Oh and I dont use visine or any other drops. I was using systane preservative free when I did use drops. I really appreciate you taking the time to respond. I think I will try and up my omega 3’s and try the brands you mentioned. I really am desperate and would try anything at this point. Thanks so much.
Oh and I also tried warm compresses to see if my ducts were clogged. I do that every night and have been for about 4 months. It does feel good and my eyes look better after I remove it but that only last about 15 minutes til they are back to the redness. Same with the cold compress.
Just another thought for you. If warm compresses help, you could have more of a
Meibomian Gland Dysfunction (MGD) causing evaporative dry eye. A topical prescription drop called Azasite can be helpful as well as oral tetracycline. There is a new for of treatment known as the LipiFlow Thermal Pulsation System. It is kind of like warm compresses and massage in a souped up technological version. Reported results are good but it will take a while to know how it really works. You might talk to your doc about these options and see if they feel any of them might help. You can Google Lipiflow and take a look at the company
Thanks so much. You have been very helpful and I appreciate it. I will look into those options. Thanks again!!
I really hate my pinguecula. I’m so insecure of it and it bring me so down especially when I have to look into peoples faces and talk to them. I tried to whiten my eyes but my GP said it will be no good and I may cause harm to my eyes. I really don’t like it and I want to get rid of it asap. Can you please help me? Or at least any medication or drops to lessen the appearance thank you and God bless you.
Pingueculas are usually not removed form the eyes as they tend to recur over time. If they start to grow onto the clear tissue that covers the colored iris they are removed once they grow far enough across. If you are having episodes of redness on occasion a steroid eyedrop may help calm it down. An episode of inflammed pinguecula is called pingueculitis. If the cosmetic appearance is very troubloing to you a new study appears to show that argon laser photocoagulation of pingueculas is a better alternative to surgical removal. Do other people comment on your pinguecula’s appearance? If they don’t, it might be worth discussing your concerns with a counselor for a few brief visits just to make sure your feelings are realistic with how it appears to other people. Then by all means pursue treatment avenues if it is having that much of an effect on your life. LASER treatment is fairly straightforward with a low complication rate, as is surgical removal.