Nasal Pterygium Research Articles

Fixation and its role in the causation, laterality and location of pterygium: a study in amblyopes and non-amblyopes

To evaluate the role of fixation in causing pterygium and determining its laterality and location. This is a prospective, observational, case-control study. Cases were defined as patients with primary pterygium who had unilateral amblyopia with eccentric fixation. Controls were age-matched patients with primary pterygium, but without amblyopia and eccentric fixation. All patients underwent complete ocular, orthoptic, and systemic examination and a detailed risk-factor assessment (latitude of residence, exposure to sunlight, sand, and a high-reflectance environment). The role of fixation in the causation, laterality and location of pterygium was evaluated. Fisher's exact test, the unpaired t-test, and odds ratio (OR) were carried out to determine the significance of the observations. The mean age of subjects was 47.1±5.25 years in cases (n=107) and 48.2±4.75 years in controls (n=310; P=0.78). As far as known risk factors were concerned, both groups were evenly matched. Among the cases, 88 (82.2%) patients demonstrated suppression of the amblyopic eye and 19 (17.8%) patients had abnormal retinal correspondence (ARC). Patients with suppression had a unilateral pterygium in the better (fixating) eye, whereas those with ARC had bilateral pterygia. Among the controls, 192 (61.9%) eyes had bilateral pterygia and 118 (38.1%) eyes had unilateral pterygium. In controls, the dominant eye had a higher prevalence of pterygium. All patients in both groups had a nasal pterygium. Pterygium and fixation were strongly associated (P=0.007; Fisher's exact test; OR -15.98; P=0.008). Fixation appears to have an important role in causing pterygium and determining its location and laterality.

Randomized Trial of Pterygium Surgery with Mitomycin C Application Using Conjunctival Autograft versus Conjunctival-Limbal Autograft

To compare the outcomes of free conjunctival autograft (CAU) versus conjunctival-limbal autograft (CLAU) in the prevention of recurrence after pterygium surgery with adjunctive mitomycin C application in patients with primary or recurrent pterygia. Prospective, randomized study. Eighty-seven eyes of 86 patients with primary or recurrent nasal pterygia were included. All eyes underwent pterygium excision followed by removal of subconjunctival fibrovascular tissue and application of 0.02% mitomycin C for 3 minutes. The eyes then were assigned randomly to receive either CAU (44 eyes) or CLAU (43 eyes). Rate of conjunctival or corneal recurrence of pterygium after surgery. A follow-up of at least 12 months (mean, 14 ± 2.2 months) was achieved in 78 eyes of 78 patients, including 39 eyes in the CAU group (31 primary and 8 recurrent pterygia) and 39 eyes in the CLAU group (33 primary and 6 recurrent pterygia). After surgery, no eye in the CLAU group developed pterygium recurrence; however, recurrence was seen in 2 eyes (5.1%) in the CAU group, including 1 of 31 patients (3.2%) with primary pterygia and 1 of 8 patients (12.5%) with recurrent pterygia. There was no statistically significant difference in recurrence rates between the 2 groups or in the primary and recurrent subgroups. In the CLAU group, a localized pannus formation at the donor site of the limbal graft was noted in 5 eyes (12.8%), with the appearance of pseudopterygium in 1 eye. There was no significant difference in recurrence rates of pterygium after surgery with mitomycin C application between the CAU and CLAU groups, more remarkably in primary cases. Limbal damage was seen in some eyes with CLAU.

Preoperative Subpterygial Mitomycin C Injection Versus Limbal Conjunctival Autograft Transplantation for Prevention of Pterygium Recurrence

To evaluate postoperative outcome and recurrence rate after primary pterygium excision using preoperative Mitomycin C (MMC) injection versus limbal conjunctival autograft transplantation (LCAT). Ninety-one eyes with primary pterygium were divided into 2 groups. Group A eyes (included 48 eyes) were operated upon with pterygium excision 1 month after subpterygial injection of MMC 0.015%. Group B eyes (included 43 eyes) were operated upon with pterygium excision followed by LCAT technique. Pterygium regrowth over the cornea for 1 mm or more was considered as a recurrence. The follow-up period was 24 months. In group A, reported recurrence was found in 2 (4.2%) eyes with a complication rate of 16.80%. While in group B, recurrence was reported in 4 (9.3%) eyes with a complication rate of 11.63%. No serious postoperative complications were reported. There was no statistically significant difference between the 2 groups regarding the recurrence rate as well as the complication rate. Both techniques used in the current study proved to be effective in reducing the recurrence rate after excision of primary nasal pterygium with minimal postoperative complications. Preoperative MMC injection was technically easier, with shorter operative and preservation of healthy conjunctiva. However, LCAT is a one-stage procedure and independent from adjunctive pharmacological or radiation therapies with their hazards.

Reversal of Sensation of Conjunctival Autograft after Pterygium Surgery

To evaluate sensation change at nasal and superior conjunctival and corneal quadrants after pterygium surgery with conjunctival autograft. A prospective study was carried out in 14 patients. Seventeen eyes were operated for primary nasal pterygium. Sensation in nasal and superior conjunctival and corneal quadrants was measured with a Cochet-Bonnet aesthesiometer (CBA) before, and at 2 weeks, 1 month, and every month for 6 months after surgery. Preoperative and postoperative measurements were recorded and analyzed with Wilcoxon signed-rank test. The mean patient age was 53.5 years (range 44-68). All patients had nasal primary pterygium and completed the 6-month follow-up. The conjunctival autograft was correctly positioned and fixed in all eyes with fibrin glue. Mean ± SD sensations in conjunctival autograft were none (p<0.05) at 1 month, 4.28 ± 5.34 mm (p<0.05) at 2 months, 12.85 ± 2.67 mm (p<0.05) at 3 months, and returned to normal level, 23.57 ± 2.43 mm (p>0.05), at 4 months. Mean sensations in superior conjunctival area where the autograft was harvested were 11.42 ± 5.56 mm (p<0.05) at 1 month, and returned to normal level, 22.14 ± 2.67 mm (p>0.05), at 2 months. Mean sensations in nasal corneal area after surgery were 7.81 ± 4.06 mm (p<0.05) at 2 weeks, 26.42 ± 2.43 mm (p<0.05) at 1 month, and returned to normal level, 49.00 ± 3.38 mm (p>0.05), at 2 months. Mean sensations in superior corneal area did not change postoperatively. Anesthesia at first month and hypoesthesia at second and third month at conjunctival autograft was observed after pterygium surgery. Additionally, hypoesthesia was observed at nasal cornea and superior bulbar conjunctiva at the first month.

Evaluation of Conjunctival Graft Thickness after Pterygium Surgery by Anterior Segment Optical Coherence Tomography

Background: To evaluate changes in thickness of the conjunctival graft after pterygium surgery by anterior segment optical coherence tomography (AS-OCT).Materials and Methods: Eleven eyes of 11 patients with primary nasal pterygium underwent excision followed by free conjunctival autograft. Imaging with AS-OCT was performed at 1 week, 1 month and 3 months after surgery to measure thickness of the conjunctival graft at 1, 2 and 3 mm posterior to the scleral spur. As the control, thickness of the normal bulbar conjunctival epithelium in the temporal area was also measured at the same locations.Results: Average thickness of the graft decreased from 458 ± 171 µm at 1 week after surgery to 306 ± 64 µm at 1 month (p < 0.0001). Although the graft thickness decreased to 291 ± 124 µm at 3 months postoperatively, the difference between 1-month and 3-month values was not statistically significant (p = 0.94). Average thickness of the normal conjunctival epithelium was 58 ± 13 µm, 60 ± 19 µm and 61 ± 12 µm at 1 week, 1 month and 3 months after surgery, respectively, with no statistically significant difference. Graft thickness was significantly greater than thickness of the normal conjunctival epithelium at various time points (p < 0.05).Conclusion: Evaluation by AS-OCT showed that there was significant thickening of the conjunctival graft at 1 week after pterygium surgery which continued to decrease up to 3 months. Quantitative data by AS-OCT allows accurate evaluation of the conjunctival changes over time.

Surgically induced necrotizing scleritis after primary pterygium surgery with conjunctival autograft

BackgroundAlthough pterygium excision with conjunctival autograft is a widely performed surgical procedure, surgically induced necrotizing scleritis (SINS) following such surgery is extremely rare.MethodsA 68-year-old man underwent nasal pterygium excision with conjunctival autograft uneventfully. On postoperative day 17, the conjunctival graft was avascular, with epithelial defect. Although topical steroid and antibacterial treatments were continued, the graft and sclera melted, with the ischemic sclera showing gradual thinning. The thinning area spread to the adjoining cornea, and active inflammation with epithelial defect was observed adjacent to the site of thinning.ResultsSystemic and microbiological examination was noncontributory. The patient was suspected of having SINS, and administration of oral prednisolone was started. Although the necrotic area was reduced temporarily, medication was discontinued due to nausea, and the area of thinning increased. Conjunctival flap surgery was later performed, and the graft was well accepted.ConclusionsSINS must be considered in the differential diagnosis of patients with scleritis following pterygium surgery, especially if radiation or mitomycin C has not been used.

Effect of Pterygia on Refractive Indices, Corneal Topography, and Ocular Aberrations

To investigate the effect of different sizes of pterygium on ocular aberrations along with corneal refractive changes, keratometry, and corneal topography. Forty eyes of 34 patients who had different sizes of primary nasal pterygium and 40 eyes of 22 age- and sex-matched healthy subjects without a clinical diagnosis of pterygium or pinguecula were enrolled in this study. All patients underwent a measurement of uncorrected and best spectacle-corrected visual acuities, corneal topography, and ocular aberrations. The pterygia sizes were measured with a slit lamp by using a slit beam of light. All indices (topographic/refractive spherical and astigmatic values and topographic/refractive spherical equivalent) were higher in the pterygia group than in the control group. Both horizontal length (Rho: 0.64 and P < 0.001) and width of pterygia (Rho: 0.68 and P < 0.01) were found to be correlated with corneal astigmatism. When the root mean square values of ocular aberrations were compared among the groups (control, small, medium, and large size pterygia), differences were found to be statistically significant regarding all parameters including total (P < 0.001), tilt (P < 0.001), higher order aberrations (P < 0.001), total coma (P < 0.001), total trefoil (P < 0.001), total tetrafoil (P < 0.001), total spherical aberrations (P = 0.004), and higher order astigmatism (P < 0.001). Moreover, the root mean square values of ocular aberrations seem to strongly correlate with both horizontal length and width of pterygia. Pterygia, particularly with larger sizes, seem to be correlated with increased ocular aberrations. Moreover, increase of ocular aberrations may become one of the indications for surgical treatment if this association is supported by further investigations.

Comparison of fibrin glue and suture technique in pterygium surgery performed with limbal autograft.

To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15(th) day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

Successful Treatment of Necrotizing Scleritis after Conjunctival Autografting for Pterygium with Amniotic Membrane Transplantation

Purpose: To report a case of necrotizing scleritis after pterygium surgery with conjunctival autografting (CA) and intraoperative Mitomycin C (MMC) and its treatment with amniotic membrane transplantation (AMT) and systemic steroid.Methods: A 41-year-old woman who had recurrent nasal pterygium underwent pterygium excision with CA and intraoperative MMC. Two weeks after surgery, graft necrosis and necrotizing scleritis associated with severe pain and irritation were observed on her operated eye.Results: Pulse steroid treatment (intravenous 1 g methylprednisolone for 3 days) was initiated and AMT was performed for ocular surface reconstruction. Over the next 2 weeks, the graft vascularization was complete and there was no complication which required further treatment.Conclusions: Necrotizing scleritis is a rare complication of CA with MMC. Systemic steroid therapy is necessary for subsiding ocular inflammation and AMT can be performed for ocular surface reconstruction.

Comparison of Pterygium Recurrence Rates in Hispanic and White Patients After Primary Excision and Conjunctival Autograft

To evaluate the impact of Hispanic and white ethnicity on the recurrence rates of pterygia after primary excision and conjunctival autograft (CAG) in a southern California population. A retrospective case-control review comparing 15 Hispanic and 11 white patients with primary nasal pterygia was performed. All participants received pterygium excision with superior limbal CAG by 1 of 3 surgeons and postoperative topical steroids for 2 months. The main outcome measure was recurrence after surgery, defined as fibrovascular tissue over the corneoscleral limbus onto clear cornea in the area of previous pterygium excision. Average duration of follow-up in the Hispanic and white groups were 9.3 +/- 9.8 months and 13.0 +/- 10.7 months, respectively (P = 0.39). During this follow-up period, there was a statistically significant difference in the pterygium recurrence rate between the Hispanic patients, 6 of 15 (40%), and the white patients, 0 of 11 (0%) (P = 0.02). The average time to recurrence was 3.4 +/- 1.1 months (range, 1.9-5.0). The difference in average age, male/female composition, and follow-up time between the Hispanic and white patient groups studied was not found to be statistically significant (P > 0.05). Hispanic ethnicity is a potentially important risk factor for recurrence of primary pterygia treated with CAG.

Effect of Subconjunctival Bevacizumab on Primary Pterygium

To investigate the effect of subconjunctival bevacizumab on primary pterygium. A patient with an inflamed nasal primary pterygium, refractory to artificial tears and naphazoline, was enrolled in this study. After pretreatment with topical proparacaine and moxifloxacin, 0.05 mL of bevacizumab (1.25 mg/0.05 mL) was injected subconjunctivally at the limbus. Clinical signs of irritation, redness, and vascularization were monitored over 7 weeks. At 1 week postinjection, irritation and hyperemia showed near-total regression. At week 2, the pterygium maintained this appearance. By week 7, the degree of vascularity and symptoms of irritation had regressed to its preinjection state. Treatment of primary pterygium with subconjunctival bevacizumab results in a short-term decrease in vascularization and irritation. Further long-term studies should investigate the efficacy of bevacizumab as an adjunct to surgical excision or combined topical treatment targeting other growth factors involved in pterygium pathogenesis.

Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular

To compare recurrence rate, complications, and biomicroscopical findings after conjunctival autograft pterygium surgery with the use of a fibrin glue (Tissucol Duo, Baxter AG, Vienna, Austria) or suture (7-0 silk). Patients with nasal pterygium were included in two groups of conjunctival autograft surgery. In 9 of them the graft was sutured to the surrounding conjunctiva and in 8 of them the graft was fixed to the conjunctiva using fibrin glue. 17 patients (17 eyes) 41.2% women and 58.8% men were surgically treated. Mean patient age was 59.8 years. Five of the patients presented recurrence for simple excision and 12 presented primary pterygium. The extent of corneal invasion was 2 to 4 mm. In the suture group, 33.3% of the patients experienced pain after surgery compared to none in the fibrin glue group. In the suture group, 44.4% of the patients presented inflammation after surgery compared to none in the glue group. One patient from the glue group lost the graft and presented a recurrence one month later. The use of fibrin glue in pterygium surgery reduces patient symptoms, inflammation and discomfort. The rate of recurrence seems to be similar in both procedures.

Use of tissue adhesives in ophthalmology

Use of tissue adhesives in ophthalmology

Unilateral Idiopathic Dilated Episcleral Vein with Secondary Open Angle Glaucoma (Radius–Maumenee Syndrome) in an African – A case report and literature review

A 69-year-old woman was seen in the eye clinic of the Olabisi Onabanjo University Teaching Hospital [OOUTH], Sagamu, south-west Nigeria, with irritation in the right eye due to a vascular nasal pterygium, but asymptomatic in her left eye. Examination revealed dilated and tortuous conjunctival and episcleral vessels in her left eye with no apparent cause. She later developed secondary glaucoma in that eye. A diagnosis of left idiopathic dilated episcleral vein with secondary open angle glaucoma [Radius Maumenee syndrome] was made. She was treated both medically and surgically. This rare case in an African woman is presented in order to highlight the possibility of secondary vascular glaucoma in a patient with chronic redness of the eye without symptoms of discomfort or allergy. Keywords: idiopathic, dilated episcleral veins, secondary glaucoma, NigeriaNigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 20-22

Comparison of Fibrin Sealant and Sutures for Conjunctival Autograft Fixation in Pterygium Surgery: One-Year Follow-Up

Aims: To evaluate the efficacy and safety of fibrin sealant in conjunctival autograft fixation in pterygium surgery. Methods: Prospective, comparative, interventional case series. 40 eyes of 40 patients with nasal primary pterygium, 24 male and 16 female, were enrolled. The patients were assigned to two groups and each contained 12 male and 8 female based on the pterygium area encroaching onto the cornea. In one group the conjunctival autograft was attached to the sclera with fibrin sealant and the other group with nylon 10–0 sutures. All the patients were followed up postoperatively on days 1, 3, 7 and 14 then at months 1, 2, 6 and 12. The main outcome measures included operating time, postoperative symptoms, graft success, recurrence rate and complications. Results: The average operating time was significantly shorter (p < 0.001) in the fibrin sealant group and fewer postoperative symptom complaints were received as well. By the end of 1-year follow-up, the recurrence rate was 5% in the fibrin sealant group and 10% in the suture group (p = 1.000), and there was no statistically significant difference in complications (p > 0.05) between the two groups. Conclusions: It is safe and effective to use fibrin sealant for conjunctival autograft fixation. This method causes much fewer postoperative symptoms and shortens surgery time significantly, and the long-term results are also favorable.

Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

PurposeTo evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium.MethodsThirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations.ResultsThe mean patient age was 57.9±10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05±5.78 weeks. The mean surgery time was 18.04±5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive.ConclusionsThe use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms. Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Polyglactin sutures versus nylon sutures for suturing of conjunctival autograft in pterygium surgery: a randomized, controlled trial

To compare the use of polyglactin sutures versus nylon sutures for conjunctival autograft suturing in pterygium surgery. A prospective, randomized, controlled, clinical trial was conducted, in which 32 eyes of 32 patients with primary nasal pterygium were randomized to undergo pterygium surgery with the use of nylon sutures or polyglactin sutures for conjunctival autograft suturing. Patients were followed up for 3 months. Outcome measures included postoperative discomfort according to a visual analogue scale (VAS), graft hyperaemia, graft oedema and tarsal conjunctival papillary reaction. There was no significant difference in the postoperative discomfort as assessed by VAS in both groups at all follow-up visits. Patients who had polyglactin sutures for suturing conjunctival autograft were noted to have more tarsal conjunctival papillary reaction at day 1 (p = 0.01) and more graft hyperaemia at week 1 (p = 0.019) after the operation. At 4 weeks postoperatively, significantly more nylon sutures remained on the autograft (p = 0.021), some of which were buried and could not be removed. Both polyglactin and nylon are effective suture materials for autograft suturing in pterygium surgery and cause comparable postoperative discomfort. Polyglactin sutures resulted in slightly more conjunctival reaction in the early postoperative period compared with nylon sutures.

Plica Semilunaris Temporal Ectopia

To study whether plica semilunaris (PS) temporal ectopia is associated with primary nasal pterygia and whether such hypothetical ectopia is linked to with-the-rule astigmatism so that a discussion of the clinical and surgical implications of such possible findings might take place. Cross-section observational study of 208 consecutive eyes of 152 cases and 169 eyes of 109 control subjects enrolled for 6 months. Four PS position grades were designed. Grade 1 features a grossly vertical PS position. Grades 2 and 3 involve temporal displacement and an abnormal PS tilt. Grade 4 involves PS obliteration with possible associated temporal caruncle dragging. Pterygium corneal encroachment, pterygium fleshiness, and manifest refraction were recorded. PS position was significantly displaced temporally in pterygium-affected eyes (P = 2 x 10(-4)). Corneal encroachment (P = 2.1 x 10(-5)), pterygium fleshiness (P = 2.7 x 10(-5)), and age (P = 1.3 x 10(-2)) were positively correlated with PS position grades > 1. The presence of with-the-rule astigmatism was significantly linked to PS position grades > 1 (P = 0.01). Primary nasal pterygia result in PS temporal ectopia, and PS position grades (more than grade 1) are linked to the presence of with-the-rule astigmatism. These findings are consistent with the exertion of tractional forces at both pterygium ends. In eye abduction, medial canthus structures (PS, caruncule) may be dragged temporally. Thus, pterygium-related corneal traction may not always significantly increase in eye abduction. PS temporal ectopia may influence the decision to remove PS during pterygium surgical excision.

Fibrin Glue versus Vicryl Sutures for Primary Conjunctival Closure in Pterygium Surgery: Long-Term Results

Purpose: To compare the long-term results of conjunctival closure with fibrin adhesive or Vicryl sutures in pterygium surgery. Methods: The study was performed in 81 patients (81 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative administration of mitomycin C 0.02%. Patients were randomized to undergo conjunctival closure with a fibrin adhesive (Quixil) (n = 42) or Vicryl sutures (n = 39). Clinical assessment was performed on postoperative days 1, 3, 10, and 21 and thereafter at 3, 6, and 12 months. All patients completed a questionnaire at each follow-up visit grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, overall satisfaction, and recurrence rate. Results: Average operative time was 16 min in the fibrin-glue group and 28 minutes in the Vicryl-suture group (p < 0.05). Significantly less pain and discomfort were noted in the subjects treated with glue than in controls (p < 0.05). Satisfaction was significantly higher in the study group (p < 0.04). There were no complications during follow-up period in the glue-treated patients; one patient in the suture group had a medically treatable corneal dellen. At the end of follow-up, recurrent pterygium developed in five (11.9%) eyes of the fibrin-glue group and in three (7.7%) eyes of the Vicryl-suture group (p < 0.05). Conclusions: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient pain compared with suturing. However, it may be associated with a higher recurrence rate.

Pterygium Surgery

To compare the short-term results of conjunctival closure in pterygium surgery using fibrin adhesive versus Vicryl sutures with respect to operative time, postoperative ocular signs and symptoms, and overall patient satisfaction. A comparative prospective randomized clinical trial was performed in 65 patients (65 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative mitomycin C. Patients were randomized to undergo conjunctival closure with a fibrin tissue adhesive (Quixil; n = 39) or 8-0 Vicryl absorbable interrupted sutures (n = 26). Clinical assessment was performed on days 1, 3, 10, and 21 after surgery. Patients completed a questionnaire at each follow-up visit, grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, and overall satisfaction. Average operative time was 16 minutes (range, 14-16 minutes) in the fibrin glue group and 20 minutes (range, 20-29 minutes) in the Vicryl suture group (P < 0.05). Significantly less pain, photophobia, foreign body sensation, irritation, epiphora, itching, local hyperemia, conjunctival chemosis, and dry eye were noted in the subjects treated with glue than in controls (P < 0.05). There were no complications during the 3-week follow-up period in the glue-treated patients. One of the patients in the suture group had a medically treatable corneal delle. The use of fibrin glue in pterygium surgery significantly reduces operative time and patient symptoms, pain, and discomfort. A longer follow-up is needed to evaluate the influence of fibrin glue on rate of recurrence and long-term complications.