‘You see how the growth has grown across the eye? You’ll never see this in England.’
I’m in theatre again, scrubbed up and staring down towards our patient. Today, we are dealing with a pterygium, a benign growth of the conjunctiva. This is where the white of the eye grows inwards to the pupil, potentially covering the cornea and interrupting vision. This was the case for our patient today, and so he had been admitted to have it cut out.
The condition is also called ‘surfer’s eye’, owing to the fact that it is associated with prolonged exposure to ultraviolet light, sand and low humidity. Given you’d be hard pushed to even find the first two in the UK, it’s less of a mystery why it mainly presents in areas like the Caribbean.
‘Is it still stinging?’
The surgeon dabs gently at the eye with a cotton wool bud. As with any surgery, it’s crucially important to make sure the patient can’t feel anything before you start. With the all clear given, he proceeds to finely cut and scrape against the small, red growth. Slowly but surely, the cornea is unearthed.
The increased prevalence of pterygia is one of many variations I’ve picked up in eye disease between different populations during my stay. White patients are more susceptible to macular degeneration, for example, whilst black patients are more likely to develop open angle glaucoma. This diversity means that doctors must pay close attention to their patient’s background: whether ethnic, social or geographical. They can provide useful clues when you come to decide what disease the patient is most likely to have.
The fleshy pterygium is now completely cut out (excised), but this means that there is no longer any conjunctiva covering the area either. The underlying sclera cannot be left exposed, and so the surgeon takes a cut from the inside of the eyelid as a replacement. The graft is fixed into place with extraordinarily small sutures to complete the job.
It’s exciting seeing all these new and unusual conditions, but it’s also an important reminder that medicine is not the same the world over. Though I probably won’t be asking after surfing as well as cigarettes in my histories, I do feel better for knowing.