What Is a Pinguecula?

Patients spot a small raised yellow or cream-colored bump on the white of the eye and worry it is a growth, a cyst, or something dangerous. It may occasionally get red and irritated, which draws attention to it. They want to know what it is, whether it will spread or harm their vision, and whether anything needs to be done about it.

A pinguecula is a deposit of altered protein and fatty material in the conjunctiva, the thin membrane covering the white of the eye. Years of ultraviolet light, wind, and dust cause this surface tissue to thicken and take on a slightly raised, yellowish appearance. It sits in the exposed area of the white of the eye, most commonly on the nasal side, in the space between the lids where sunlight reaches most directly.

For your eyes, this is reassuring: a pinguecula is a cosmetic and comfort issue rather than a vision problem. Because it is slightly raised, the tear film can break up over it and leave that spot dry, which is why it can feel gritty or look red, especially in wind or sun. It does not invade the cornea and does not blur vision. Its main significance is as a marker of sun exposure, and because it can be a precursor to the related growth called a pterygium, which does grow onto the cornea.

Pingueculae develop from chronic ultraviolet exposure that causes degenerative changes in the surface tissue of the eye, with wind, dust, and dryness contributing. They are more common with age and in people who spend a lot of time outdoors or in sunny, dry, or dusty environments. They grow very slowly, if at all, and typically stay small and stable for years.

Most of the time a pinguecula is asymptomatic. When it becomes irritated, a condition called pingueculitis, it can turn red and feel inflamed, usually after sun, wind, or dryness, and then settle with lubrication. The important distinction is from a pterygium: a pinguecula remains a bump confined to the white of the eye, whereas a pterygium is a wing-shaped growth that extends onto the cornea and can affect vision. A pinguecula does not turn the eye's vision blurry, and while it can coexist with or precede a pterygium, it does not itself require removal for visual reasons.

A pinguecula is benign and rarely a concern, but have it looked at if:

• It grows noticeably, changes color, bleeds, or develops an unusual surface, since other lesions of the eye's surface can occasionally look similar and need to be told apart.
• It becomes persistently red, painful, or inflamed and does not settle with lubrication.
• You notice tissue beginning to extend from it onto the clear cornea, which would suggest it is becoming a pterygium.

Otherwise, a stable, comfortable yellowish bump is simply monitored.

The diagnosis is usually made simply by examining the lesion at the slit lamp, where its yellowish color, raised texture, and location on the white of the eye are characteristic. The doctor confirms that it is confined to the conjunctiva and is not extending onto the cornea, distinguishing it from a pterygium. If a lesion looks atypical, is growing, or has unusual features, the doctor considers other diagnoses and may photograph it to track it over time or, rarely, recommend a biopsy to be certain.

Most pingueculae need no treatment beyond reassurance and protection. Artificial tears relieve the dryness and gritty feeling, and UV-blocking sunglasses and a hat reduce irritation and slow any progression. When a pinguecula flares and becomes red and inflamed, a short course of anti-inflammatory or mild steroid drops prescribed by the eye doctor can calm it. Surgical removal is not usually necessary and is considered only if the lesion is chronically inflamed and uncomfortable despite treatment, interferes with contact lens wear, or is a significant cosmetic concern; because it is benign, removal is elective rather than medically required.

• Do not assume every bump on the eye is a harmless pinguecula; an unusual, growing, or discolored lesion should be checked.
• Do not neglect UV protection, since sun exposure drives these changes and the related pterygium.
• Do not use steroid drops on your own for recurring redness, as prolonged steroid use carries eye risks and should be supervised.
• Do not rub the eye when it feels gritty, which only adds irritation.
• Do not seek removal expecting a vision benefit, since a pinguecula does not affect vision.

Call for an evaluation if a bump on the white of your eye is enlarging, changing in appearance, staying red and irritated despite artificial tears, or starting to extend toward the cornea. Patients in the Hanover area can have it examined and reassured or treated as needed. Any spot on the eye that grows quickly or looks unusual is worth having checked to confirm what it is.

A pinguecula is a benign, sun-related yellowish bump on the white of the eye that does not spread to the cornea or affect vision and usually needs only lubrication and sun protection. Have a changing, growing, or persistently irritated bump evaluated at May Eye Care Center to confirm it is nothing more.