Pinguecula is a small yellow formation localized in the nasal half of the conjunctiva. Depending on the diameter, it may occur latently or provoke discomfort, a feeling of dryness and a foreign body, hyperemia of the eyes. Diagnostics of the pinguecula includes external examination, fluorescence angiography, biomicroscopy, fern test, OCT. Conservative treatment is reduced to the use of moisturizing drops, ointments, artificial tear preparations. Anti-inflammatory and antibacterial therapy is indicated for the development of secondary complications. In the absence of the effect of drug treatment, surgical removal of the pinguecula is recommended.
Pingvecula is a disease in ophthalmology, the main manifestation of which is the formation of a yellowish seal on the orbital conjunctiva. The first information about this pathology dates back to 1550 BC. In the medical records of the ancient Egyptians, the penguin was described as “fatty deposits in the eye.” The disease can occur in isolation or be one of the manifestations of a genetically determined Gaucher disease. In 95% of cases, the penguin is detected at the age of 50 to 60 years. With prolonged contact of the conjunctiva with factors provoking the development of this pathology, the appearance of neoplasms at the age of 20-30 years is possible. The penguin is equally diagnosed among males and females. People living in hot and dry climates are more at risk of developing the disease.
The etiology of the pinguecula has not been fully studied. As a rule, the disease develops against the background of age-related or dystrophic changes in the conjunctiva. With age, the intensity of metabolic processes decreases, which leads to the accumulation of metabolic products of fats and proteins in the body. A decrease in the level of metabolism is associated with the development of the penguin. Also, in the pathogenesis of this pathology, degeneration of collagen fibers in the stromal part of the conjunctiva is noted, followed by a decrease in the thickness of the epithelium. The trigger of the disease is prolonged exposure to ultraviolet rays. UV radiation stimulates the synthesis of abnormal fibrillar protein (elastin) by fibroblasts, which exacerbates dystrophic changes in the conjunctiva. Therefore, the risk group includes people whose work is associated with prolonged exposure to the sun.
In addition, the development of the pinguecula provokes periodic irritation of the conjunctiva of the eyes by strong wind, smoke, exhaust gases, toxic fumes, industrial chemicals. Some experts believe that the risk of developing pathology increases with prolonged wearing of contact lenses. A pinguecula can form against the background of traumatic conjunctival injuries, scarring or chronic conjunctivitis. The negative effect of infrared radiation on the occurrence of the disease has been proven. At the same time, the sclera, which has a reflective ability, potentiates the negative effect of infrared and ultraviolet radiation on the conjunctiva and aggravates the progression of the pinguecula.
Pingvecula in 50% of cases is a bilateral disease with localization in the medial conjunctiva. There is a tendency to slow progression, which is manifested by an increase in the size of the neoplasm. The pathology is characterized by a benign course. Cases of malignant degeneration of the pinguecula have not been observed. As a rule, patients independently detect the appearance of a small yellow area of compaction against the background of an unchanged bulbar conjunctiva. The development of the disease does not lead to a decrease in visual acuity, with a small size does not affect the quality of life of patients.
At the initial stages, the penguin is characterized by a latent flow. Clinical manifestations are noted with an increase in the diameter of the neoplasm. Patients complain of discomfort accompanied by a feeling of dryness in the affected eye. Periodic irritation of the pinguecula leads to conjunctival hyperemia. Patients note the sensation of a foreign body, which provokes the development of lacrimation. In rare cases, the symptom of a pingvecula is a clouding of the cornea. Prolonged irritation of the sealing zone on the conjunctiva leads to the appearance of pingveculitis. Conjunctivitis may develop a second time against the background of this disease. With the formation of defects in the terminal arcades of the limb, the transformation of the pinguecule into the pterygium is possible. Patients with pingueculitis report that the eyes after the development of this pathology have become more sensitive to dust, when looking at a light source or solid particles entering the eye.
The diagnosis of the pinguecula is based on anamnestic data, the results of external examination, fluorescence angiography, biomicroscopy, fern test, optical coherence tomography (OCT). During an external examination, a small yellowish formation of a rounded shape is revealed. By the method of fluorescent angiography, it is possible to visualize disturbances in the microcirculation of the medial conjunctiva. During the transformation of the pinguecula into the pterygium, changes in the zone of the terminal arcades of the limb are determined. This study indicates the passage of the anterior ciliary artery under the seal zone. In the central parts of the pinguecula, the vessels are poorly expressed.
Biomicroscopy makes it possible to identify a yellow translucent formation, practically devoid of blood supply. This pathology is characterized by prelimbal, less often limbal localization. At the initial stages of transformation into pterygium by biomicroscopy, it is possible to detect a slight subepithelial ingrowth of the pinguecule into the cornea area. During OCT, the shape, size, and degree of penetration into the underlying structures of the eye are determined. When transformed into a pterygium, there is a subepithelial growth of the conjunctival stroma, which passes into the cornea in the direction of the Bowman’s membrane. The results of the furning test indicate the presence of abnormal components in the tear film covering the penguin. Differential diagnosis is performed with a limbal sarcoid nodule.
With an asymptomatic course of the pinguecula, therapy is not required. In the presence of discomfort, complaints of dryness, hyperemia and foreign body sensation, conservative treatment is recommended. In the absence of signs of inflammation and the presence of only dryness, local application of moisturizers is indicated. With the development of hyperemia of the pinguecula or the surrounding conjunctiva, local administration of anti-inflammatory or antibacterial drops is necessary. During the treatment period, it is necessary to refuse to wear contact lenses, since they additionally injure the conjunctiva and the cornea.
Surgical removal of the pinguecula is performed in the absence of the effect of conservative therapy, frequent development of pingueculitis, secondary conjunctivitis, signs of transformation into pterygium. In addition, surgical intervention is resorted to in patients with an asymptomatic course of pathology to eliminate a cosmetic defect. The operation to remove the pinguecula is performed under regional anesthesia using an excimer laser. In the postoperative period, it is recommended to use sterile bandages on the operated eye. The purpose of the bandage is to protect the visual organ from ultraviolet radiation, dust, toxins and other substances that irritate the eyes and can lead to the re-formation of the pinguecula. After surgery, the disease is not prone to recurrence.
Prognosis and prevention
To prevent the development of pinguecula, it is recommended to wear sunglasses during prolonged exposure to the sun. Patients should normalize their metabolism by correcting their diet. When living in an area with a dry and hot climate, it is necessary to moisten the eyes with special drops, ointments or artificial tear preparations. If discomfort appears or secondary complications of the pinguecula are attached, you need to consult an ophthalmologist. Examination by a specialist is subject to all patients with the appearance of neoplasia on the surface of the conjunctiva to establish a diagnosis and choose treatment tactics.
The prognosis for life and ability to work with a penguin is favorable. As a rule, this neoplasm does not affect the quality of life of patients and does not lead to a decrease in visual acuity.