Pterygium: Nonsurgical Treatment Using Topical Dipyridamole – A Case Report
A 35-year-old female Caucasian patient presented with a pterygium in her right eye. She began to notice it approximately 6 weeks prior to her visit, and it rapidly became increasingly symptomatic. She complained of a foreign body sensation, burning, and dryness, accompanied by constant and uncontrolled blinking.\nThree views of the patient's eye in its pre-treatment state are depicted in the figures [fig. , fig. , fig. (left side)]. There was a 1.5-mm area of raised conjunctival tissue that extended slightly onto the nasal cornea obstructing the limbus. The tissue was raised approximately 1 mm. There was moderate vascularity of the lesion, and the underlying scleral vessels were obscured. Moderate conjunctival hyperemia was noted both at and medial to the pterygium. There appeared to be some pigmentation at the corneal leading edge of the pterygium. The ophthalmologist performing the examination noted that the lesion invaded the cornea. The cornea was otherwise clear, and the iris was unremarkable. The anterior chamber was clear and quiet. The lids and lashes were unremarkable. Utilizing Johnston, Williams & Sheppard's comprehensive pterygium classification system [], this was graded as a stage II to III, V3, C3, K2, P1 pterygium.\nTreatment with topical steroids was recommended, but the patient declined. Instead, treatment with topically applied dipyridamole (1.68 × 10–4 M in normal saline solution) was initiated, starting with 1 drop twice daily to the affected area. Slight transient stinging was felt immediately upon application. The patient reported a significant reduction of dryness and burning within days of starting treatment. She continued applying the drops, and as her symptoms improved, she reduced the application to once daily. She continued applying the drops for 12 months with intermittent breaks of several weeks when she felt asymptomatic. The patient noticed that symptoms of dryness recurred within a few weeks, but the lesion did not increase in size. Whenever symptoms appeared, she resumed therapy. At the end of this period, the eye was reassessed. The pterygium was markedly improved. The tissue had regressed from the limbal region of the cornea, had decreased in length from 1.5 to 1.0 mm, and decreased in height from 1.0 to approximately 0.3 mm. The conjunctival hyperemia and vascularization had resolved entirely, and the underlying scleral vessels could now be visualized. At 12 months, the pterygium was graded as stage 0 to I, V0, C2, K0, P0 [fig. , fig. , fig. (right side)]. At the time of this report, the lesion is still present, but remains at the same very mild stage as was noted at the 12-month evaluation.