# Pterygium - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, DOSAGE AND ADMINISTRATION, SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c (dailymed-loteprednol-etabonate-0.5pct-suspension.txt): "Steroid Responsive Disease Treatment: Apply one to two drops of loteprednol etabonate ophthalmic suspension into the conjunctival sac of the affected eye(s) four times daily. During the initial treatment within the first week, the dosing may be increased, up to 1 drop every hour, if necessary." · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD74 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Pterygium - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK558907/ · Pterygium - disease-level clinical article (pterygium-full.txt) · Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c, dailymed-loteprednol-etabonate-0.5pct-suspension.txt) - Verified date: 2026-08 ## Verified against - Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, DOSAGE AND ADMINISTRATION, SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c (dailymed-loteprednol-etabonate-0.5pct-suspension.txt): "Steroid Responsive Disease Treatment: Apply one to two drops of loteprednol etabonate ophthalmic suspension into the conjunctival sac of the affected eye(s) four times daily. During the initial treatment within the first week, the dosing may be increased, up to 1 drop every hour, if necessary." - No dose - referral pathway, no medicine given in primary care - Pterygium - disease-level clinical article (pterygium-clinical.txt) - Pterygium - disease-level clinical article (pterygium-full.txt) - Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c, dailymed-loteprednol-etabonate-0.5pct-suspension.txt) ## Treatment metadata - Protect the eye, treat the symptoms, refer for surgery (Referral & Advice) - Loteprednol etabonate — eye ## Complete treatment card ```text PTERYGIUM Sources: Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, DOSAGE AND ADMINISTRATION, SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c (dailymed- loteprednol-etabonate-0.5pct-suspension.txt): "Steroid Responsive Disease Treatment: Apply one to two drops of loteprednol etabonate ophthalmic suspension into the conjunctival sac of the affected eye(s) four times daily. During the initial treatment within the first week, the dosing may be increased, up to 1 drop every hour, if necessary." · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD74 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Pterygium - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK558907/ · Pterygium - disease-level clinical article (pterygium-full.txt) · Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c, dailymed- loteprednol-etabonate-0.5pct-suspension.txt) Review status: REVIEWED against Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, DOSAGE AND ADMINISTRATION, SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c (dailymed-loteprednol- etabonate-0.5pct-suspension.txt): "Steroid Responsive Disease Treatment: Apply one to two drops of loteprednol etabonate ophthalmic suspension into the conjunctival sac of the affected eye(s) four times daily. During the initial treatment within the first week, the dosing may be increased, up to 1 drop every hour, if necessary.", No dose - referral pathway, no medicine given in primary care, Pterygium - disease-level clinical article (pterygium- clinical.txt), Pterygium - disease-level clinical article (pterygium-full.txt), Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (SetID 36cfd5b8-c892-44e1-aaed- fb32d7aeca7c, dailymed-loteprednol-etabonate-0.5pct-suspension.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (1) - Patients report ocular irritation, tearing, a foreign-body sensation, cosmetic concern, and functional issues such as reduced vision or trouble fitting contact lenses [blurred vision · eye discharge · foreign body] SIGNS - what you find (3) - The lesion has three parts: an avascular leading-edge cap, a head just behind it, and a body that merges with the bulbar conjunctiva - A progressive lesion is thick, fleshy, and vascular, advancing toward the corneal center, while an atrophic one is thin, poorly vascular, and stationary [atrophy] - The presence or absence of a Stocker's line is documented on exam TESTS (2) - A comprehensive ocular exam includes visual acuity, extraocular movements, anterior segment evaluation, and detailed refraction to characterize any astigmatism - Castroviejo calipers measure the limbal chord and the extent of corneal encroachment to grade severity IF NOT THIS - what else fits (7) - Pseudo-pterygium is a conjunctival fold stuck to the cornea from inflammation; a probe passes beneath it (unlike true pterygium), and it can appear in any quadrant without progressing - A pinguecula is a yellowish nasal bulbar-conjunctival growth that is usually asymptomatic, sometimes causing mild redness or foreign-body sensation if inflamed - Nodular episcleritis blanches with 2.5% phenylephrine and is usually only mildly painful, unlike pterygium - Marginal keratitis shows a peripheral corneal infiltrate and ulceration separated from the limbus by a clear zone - A phlyctenule is a delayed-hypersensitivity nodular inflammation of the conjunctiva - Conjunctival carcinoma in situ (Bowen epithelioma) is rare and appears as a gelatinous mass - Ocular surface squamous neoplasia is a malignant mimic that must be excluded by clinical features, impression cytology, or histopathology Source StatPearls "Pterygium" - disease-level clinical article Status traced to the source above Rx: Main treatment | Short course for the inflamed pterygium - comfort only, not a cure MAIN TREATMENT 1. PROTECT THE EYE, TREAT THE SYMPTOMS, REFER FOR SURGERY (REFERRAL & ADVICE)[1st line] Adult A fleshy conjunctival growth onto the cornea driven by chronic ultraviolet, dust and wind exposure - Egypt's climate and its outdoor trades, exactly. The definitive treatment is SURGICAL EXCISION and the article says so plainly, calling surgery the preferred option. Medical treatment relieves symptoms only. Refer when it encroaches on the visual axis, causes chronic pain or persistent inflammation, induces astigmatism, restricts eye movement, or matters cosmetically. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why A fleshy conjunctival growth onto the cornea driven by chronic ultraviolet, dust and wind exposure - Egypt's climate and its outdoor trades, exactly. The definitive treatment is SURGICAL EXCISION and the article says so plainly, calling surgery the preferred option. Medical treatment relieves symptoms only. Refer when it encroaches on the visual axis, causes chronic pain or persistent inflammation, induces astigmatism, restricts eye movement, or matters cosmetically. Caution Drops do not shrink a pterygium. What the article claims for medical treatment is relief - settling the inflammation and easing discomfort that will not go away on its own (Pterygium - StatPearls - NCBI Bookshelf, NBK558907). The steroid option here is a short, supervised course for a lesion that is inflamed and uncomfortable - it is not an alternative to surgical referral, and it carries the risks every topical steroid carries. RED FLAG - Surgical referral is also indicated for chronic pain, persistent inflammation, abnormal astigmatism, or restrictive ocular motility, not only vision loss or cosmesis. RED FLAG - Ocular surface squamous neoplasia (a malignancy) can masquerade as pterygium, especially in elderly patients. RED FLAG - Growth encroaching on the visual axis, which threatens vision, or rapid growth, irregular pigmentation, or unusual appearance, which should prompt exclusion of ocular surface neoplasia. SHORT COURSE FOR THE INFLAMED PTERYGIUM - COMFORT ONLY, NOT A CURE - give alongside 2. LOTEPREDNOL ETABONATE [add-on - not a substitute] Adult 0.5% ophthalmic suspension: one to two drops into the conjunctival sac of the affected eye four times daily. Shake vigorously before use. In the first week the frequency may be increased, up to one drop every hour, if necessary. Re-examine the patient if signs and symptoms have not improved after two days. - A short course. Beyond 14 days the prescription must only be renewed by a physician after slit-lamp examination, and intraocular pressure has to be monitored from 10 days onward Peds Pterygium is a disease of years of sun and dust exposure and is not a paediatric diagnosis. The label notes that monitoring intraocular pressure is difficult in children and uncooperative patients, which is another reason not to start a topical steroid in a child outside ophthalmology. Source Loteprednol Etabonate Ophthalmic Suspension 0.5% (Sun Pharmaceutical Industries) DailyMed label, DOSAGE AND ADMINISTRATION, SetID 36cfd5b8-c892-44e1-aaed-fb32d7aeca7c (dailymed-loteprednol-etabonate-0.5pct-suspension.txt): "Steroid Responsive Disease Treatment: Apply one to two drops of loteprednol etabonate ophthalmic suspension into the conjunctival sac of the affected eye(s) four times daily. During the initial treatment within the first week, the dosing may be increased, up to 1 drop every hour, if necessary." Why The card offered lubricants in prose with no dose; StatPearls itself names a steroid for the inflamed pterygium's symptoms - artificial tears or decongestant drops give short- term comfort and a modest cosmetic improvement, and loteprednol drops add to that. The US label's licensed use covers exactly this picture, steroid-responsive inflammation of the conjunctiva, cornea and front of the eye, and sets out the regimen. Loteprednol is registered in Egypt as LOTERANOL (0.5% eye gel and ointment, 47 EGP; 1% suspension drops, 49 EGP). It is preferred over a stronger steroid because its own label reports a lower rate of clinically significant intraocular pressure rise - 1%, versus 6% for prednisolone acetate 1%. StatPearls is clear this is comfort, not cure: surgery remains its preferred option. Caution SURGERY IS THE DEFINITIVE TREATMENT, NOT THIS. The article is plain that an operation is what it would rather see. The grounds it gives for operating: sight lost because the lesion has grown across the visual axis, pain that will not settle, inflammation that keeps returning, astigmatism the lesion has induced, eye movement it restricts, and appearance. CONTRAINDICATED, label verbatim: "contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures." A red eye that might be herpetic does not get a steroid. WHAT A TOPICAL STEROID COSTS, label verbatim: "Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision, and in posterior subcapsular cataract formation." And: "In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids." The 14-day rule, label verbatim: "The initial prescription and renewal of the medication order beyond 14 days should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy and, where appropriate, fluorescein staining." And: "If this product is used for 10 days or longer, intraocular pressure should be monitored". Without a slit lamp and a tonometer, this is an ophthalmologist's prescription. Lubricants first and always - the article's own first line is artificial tears, which carry none of these risks. No specific tear product or dose is stated by any document held here, which is why no lubricant row is written. OCULAR SURFACE SQUAMOUS NEOPLASIA CAN LOOK LIKE A PTERYGIUM, especially in an older patient. Do not settle an atypical, pigmented or rapidly growing lesion with a steroid - refer it. Sun and dust are the cause: sunglasses and eye protection at work do more for an outdoor worker in Egypt than any drop. Egypt LOTERANOL 0.5% EYE GEL 5 GM ORCHIDIA 47.00 EGP LOTERANOL 0.5% EYE OINT. 5 GM ORCHIDIA 47.00 EGP LOTERANOL 1% EYE SUSP. DROPS 2.8 ML ORCHIDIA 49.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)