Author(s): El Baroudi Taieb*, Belghmaidi Sarah, Hajji Ibtissam and Moutaouakil Abdeljalil
encroachment onto the cornea associated with chroni ultraviolet light exposure [1-2]. The main histopathological change in pterygium is elastotic degeneration of conjunctival collagen [
Pterygium excision with amniotic membrane transplant is the current benchmark for treatment of a doubleheaded pterygium. The pterygium could be excised in a stepwise manner removing the pterygium 1 side at a time and waiting a minimum of 3 months apart. This allows the conjunctiva to heal and gives the surgeon the chance to harvest the same region of conjunctiva for a second time. Mitomycin C is often used as an adjuvant therapy to further reduce the rate of recurrence [5].
A pterygium is an ocular surface fibrovascular, wing-shaped encroachment onto the cornea associated with chroni ultraviolet light exposure [1-2]. The main histopathological change in pterygium is elastotic degeneration of conjunctival collagen [3]. Pterygium occurs mostly on the nasal side, which can be attributed to light coming to the temporal cornea and being focused on the nasal Cornea [4]. Double head pterygium or Kissing pterygium , that is, nasal and temporal pterygia in the same eye is rare. Through this case, we present the case of a kissing pterygium which is a rare situation, and the importance of early diagnosis and care to avoid loss of visual acuity.
Clear and informed consent for publication of images has been obtained from the patient. We report the case of a 65-year-old female who consults for a progressive decrease in visual acuity in her left eye. The interrogation discovers the notion of working in an outdoor environment without sun protection from a young age, and no ophthalmological history was found, notably pterygium surgery.
The ophthalmological examination of the right eye were without particularity, apart from a slight anterior belapharite .Examination of the left eye finds low visual acuity (counts fingers at only 2 meters) and the auto refraction was impossible. Ocular surface examination finds a densely vascularized doubleheaded ?kissing? pterygium that cover most of the cornea and hiding the visual axis (figure 1). Figure 2 shows Fuchs? patches (minute gray blemishes that disperse near the pterygium head). The examination of the lens and fundus was impossible because of the pterygium which made passage impossible. A mode B ocular ultrasound was performed and was without particularity.
The current benchmark for treatment of a doubleheaded pterygium is excision with amniotic membrane transplant has been proposed to the patient but unfortunately she refused any surgery . Faced with this situation, medical treatment based on artificial tears and local anti-inflammatory drugs was prescribed to reduce the inflammation and the gene caused by the pterygium.
Figure 1: Double head pterygium ( nasal and temporal pterygium) covering almost the entire cornea
Figure 2: Shows Fuchs? patches (minute gray blemishes that disperse near the pterygium head
Pterygium is a relatively common and benign pathology if diagnosed and treated early. Although access to care has become easy, we continue to receive in consultations patientes at advanced stages (pterygium hiding the visual axis or double head pterygium) making treatment difficult and the visual prognosis reserved.
Pterygium excision with amniotic membrane transplant is the current benchmark for treatment of a doubleheaded pterygium. The pterygium could be excised in a stepwise manner removing the pterygium 1 side at a time and waiting a minimum of 3 months apart. This allows the conjunctiva to heal and gives the surgeon the chance to harvest the same region of conjunctiva for a second time. Mitomycin C is often used as an adjuvant therapy to further reduce the rate of recurrence [5].
