Daily Mail, Tuesday, July 30, 2019 Page 49
By JO WATERS
W
HeN model thom evans
noticed tiny, unsightly
growths in the corners
of both eyes, close to his
nose, he worried they
might eventually affect his sight.
‘I was also concerned they may show up
in close-up shots in my modelling and
acting work,’ says thom, 34, a former
Scottish international rugby player, who
famously broke his neck in a Scotland v
Wales Six Nations match in 2010.
‘they were particularly noticeable when
I was tired and run down — I guess they
were red and sore as people would ask me
what they were,’ says thom, who is single
and lives in london. ‘I had a 2mm growth
in each eye.’
thom had first noticed the lumps when
he was 17 and mentioned them to an
optician, who told him they were called
pterygium, also known as ‘surfer’s eye’.
these wing-shaped triangular pinkish
wedges of fleshy scar tissue grow over the
surface of the white of the eye in response
to damage caused by ultraviolet (uv) rays.
In an estimated one in three cases, they
can grow over the front of the cornea, the
clear window at the front of the eye. they
usually grow slowly over many years and
affect both eyes, but their rate of growth
can be difficult to predict.
Harminder Dua, a professor of ophthal-
mology at the university of Nottingham
and medical adviser to the charity fight
for Sight, says that a pterygium starts out
as a benign cosmetic blemish on the white
of the eye, but if they grow and advance
they can distort the cornea (called
astigmatism) or cover the central cornea,
causing blurred vision, double vision and
they can lead to profound sight loss.
When they do affect sight, they can be
removed by surgery.
‘they can sometimes cause dryness, as
the tear film is unable to spread across the
irregular surface and breaks down,
exposing the surface and drying it out,’
says Professor Dua. this can cause irrita-
tion and inflammation, leading to redness.
‘In the most extreme cases, when a
pterygium grows over the central part of
the cornea, it obstructs the passage of
light into the eye and can cause profound
sight loss,’ he adds.
However, the
exact cause of
pterygia is
unknown. It is
more common in
Feared for
his sight:
Thom EvansMOST of us know the dangers the sun poses
to our skin and we’ll make an effort with
sunscreen. But chances are we’ll miss a key
area — the skin around our eyes.
Eyelids and the surrounding area are a hot
spot for cancer because the skin is thinner,
and it often goes unprotected.
Around 13,600 cases of eyelid cancers are
diagnosed each year, making up around 10
per cent of non-malignant skin cancers
diagnosed in the UK.
The most common types are basal cell andsquamous cell carcinomas, which may start
off as small pimples or fleshy bumps but
can grow, bleed and crust over.
Other changes you should look out for
include redness and inflammation of
the eyelids, unexplained eyelash loss,
and the eyelashes turning white, caused by
pigment cells being affected by the cancer.
You should see your GP if you notice any of
these changes.
The sun’s ultraviolet (UV) rays can also
damage the eyes, causing sunburn to theeye’s surface as well as contributing to(^) cataracts in the long term.
For example, UV damage can lead to
photokeratitis, a type of sunburn of the
cornea, the clear part at the front of the eye.
This can be treated with mild steroid drops.
Cataracts, a condition where the lens in
the eye becomes cloudy and vision is
blurred, is also thought to be accelerated
by UV damage. It is thought that sunlight
encourages proteins in the lens to clump
together, which makes it cloud over.
OTHER RISKS TO YOUR EYES IN HOLIDAY SEASON
CHOOSE THE
RIGHT PAIR
TO PROTECT yourself from sun
damage — all year round —
the advice is to sit in the
shade, wear a wide-brimmed
hat and wear sunglasses.
Sunglasses should be a
large, wraparound style that
fits tightly, to block out the
sun’s rays from all sides.
Another option is glasses
that cover your eyebrows,
the bone below your eye and
as much of the edge of your
nose as possible.
The sunglasses should also
have a CE mark, which means
they meet European safety
standards to block the sun’s
harmful UV rays.
Sunglasses without UV
protection could be worse
than wearing no sunglasses
as the dark lenses make the
pupils of your eye dilate and
let in more harmful rays.
By a former rugby star who’s had
to have two ops on his eyeballs
countries close to
the equator where
exposure to the
uv rays in sun-
light is high.
Chronic irritation
from sand, dust
and wind in a dry
climate can also
contribute. Surfers
are particularly at
risk because of
the long periods of
time they spend
in the sea, with
exposure to both
direct and reflected
uv rays.
‘In the uk, ptery-
gium growths are relatively
uncommon because of the lack of
strong sunlight, with 1 per cent of
the population, or around
670,000 people,
affected,’ says
ali Mearza, a
consultant oph-
thalmic surgeon
at Imperial
College Health-
care NHS trust,
and Ophthal-
mic Consult-
ants of london,
a private clinic.
‘In countries
such as aus-
tralia, India and africa, the preva-
lence rate can be 30 per cent.’
thom had grown up in Portu-
gal’s sunny algarve and spent
most of his free time swimming,
windsurfing and surfing. ‘although
I was careful about protecting my
skin, stupidly I didn’t wear
sunglasses,’ he says.
‘Skiing was another sport I loved,
and although I did wear goggles
some of the time, I wasn’t good
about wearing them. I didn’t
appreciate the risks from uv light
reflected off the snow.’
In his late teens, the pterygium
growths would cause his eyes to
become irritated and sore.
‘It felt like I had grit or sand in
my eye, and sometimes I’d need
eye drops for the dryness,’ says
thom. ‘But usually they didn’t
really bother me.
‘Opticians over the years had
told me they could be removed if
they affected my sight, but I was
also told they usually grow back.’
Mr Mearza says the more sun
exposure you get, the more likely
pterygium growths will become
irritating. ‘Wearing a wide-brimmed
hat or cap and wraparound close-
fitting Ce-marked sunglasses can
reduce the risk of a pterygium
causing irritation,’ he says.
‘It can be quite challenging to
get children to wear sunglasses,
but it’s good to get them used to
them early on.’
Mr Mearza says dryness caused
by a pterygium can be managed
with lubricating eye drops
and redness treated with anti-
inflammatory drops.
‘Optometrists should also
measure the pterygium regularly
to check for any progression,’
he says.
‘If the pterygium gets bigger
than 2mm to 3mm in length and
heads towards the pupil, it can
have a dramatic effect on sight
and needs to be removed with
surgery. Some people may notice
changes to their sight at this
stage, but others might not.’
this was thom’s big fear five
years ago when he was alarmed to
notice the pterygia in both eyes
were getting bigger.
‘I decided to get them removed
as I was worried they might affect
my sight,’ he says.
Surgical options, under local or
general anaesthetic, include
excision (called a bare sclera
resection), where the head and
body of the growth is removed
with microsurgery — but this has
a high recurrence rate reported as
between 24 and 89 per cent.
another option is a conjunctival
autograft, where the pterygium is
removed via surgery and then the
area underneath patched over
with a graft of tissue from
the conjunctiva, the tissue lining
the eyelid, leaving no scar. this
has a much lower recurrence rate,
of between 5 and 8 per cent.
this was the solution thom
opted for in 2014.
‘Currently, surgery and a
conjunctival autograft are consid-
ered the gold standard,’ says
Mr Mearza, who treated thom.
P
rOfeSSOr Dua and his
team at Nottingham have
published research show-
ing that injections of a
drug called 5-fluorouracil (or
5-fu) into the belly of the recur-
rent pterygium, while it is still on
the white of the eye, can stop it
advancing on to the cornea in
almost all cases.
‘usually four injections, given at
weekly intervals, are required, but
some patients need 12 or more,
says Professor Dua.
thom, who retired from
rugby in 2010 after his accident,
had one pterygium removed
in 2014 via surgery and a
conjunctiva autograft under
general anaesthetic.
the procedure took 30 minutes
and he went home a few hours
later. the growth in his other eye
was removed three years ago,
using the same approach. He’s
had no recurrence since.
‘It was a little uncomfortable for
two or three days, but fine after
that,’ he recalls.
thom now wants to get the
message across about the
importance of people protecting
their eyes with sunglasses.
‘Had I known back then that not
wearing sunglasses at the beach
would lead to growths developing
in my eyes when I grew up, I would
definitely have worn them,’ he
says. ‘I’m always careful now.’
Vital reason
you should
NEVER forget
your shades
Pictures: ALAMY/JULIETTE NEEL