Family Nurse Practitioner Exam

During a physical exam, a triangular thickening of the bulbar conjunctiva is noted. What is most likely?

1. Corneal arcus

2. Pterygium

3. Pinguecula

4. Chalazion

The correct answer is: Pterygium

The presence of a triangular thickening of the bulbar conjunctiva is indicative of a pterygium. A pterygium is a growth of tissue that can extend over the cornea, often occurring at the nasal side of the eye. This condition is known for its characteristic appearance, which includes the triangular shape of the growth that points towards the cornea. Pterygium is often associated with environmental factors, such as prolonged exposure to UV light, dust, and wind. Its formation is typically related to irritation and inflammation of the conjunctiva. Over time, the growth can advance and potentially obstruct vision if it extends over the cornea significantly. Understanding the differences among related conditions is also important. Corneal arcus, for example, refers to a gray-white ring around the cornea and is not a thickening of the conjunctiva. A pinguecula is also a growth appearing on the conjunctiva but is typically yellowish and more localized without the triangular shape. A chalazion presents as a localized swelling on the eyelid due to blocked oil glands and does not involve the conjunctiva directly. Thus, the description of a triangular thickening strongly aligns with the pathology of a pterygium.