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var. πτερύγειον (pap.)

lat. pterygium, unguis, ungula

Cognates of medical relevance: πτερυγοτομέω (V); πτερυγοτομία (N); πτερυγοτόμος (N)


In ophthalmology pterygium is a wing-shaped growth of fibrovascular tissue that usually forms over the scleral conjunctiva and progressively encroaches onto the cornea, with its base towards the inner canthus. If pterygium extends to the pupil, it can interfere with vision and lead to blindness. Although its exact cause is not fully understood, some external conditions, such as long-term light exposure, dust and low humidity, are considered its primary contributing factors, so that pterygium is more common in people who live in arid and sunny climates. The πτερύγιον has been clearly described by Greek and Latin physicians since the time of Hippocrates with investigation into its symptomatology, diagnosis, treatment and surgery. Among medical papyri, the disease is discussed in two catechism of the II century CE, P.Aberd. 11 and P.Ross.Georg. I 20.


1-2.    Etymology – General linguistic commentary

Literally «little wing», the diminutive πτερύγιον is a metaphorical noun derived from πτέρυξ, «wing», that is in itself a derivative of πτερόν, «feather, wing». All these words can be metaphorically employed for feather- and wing-like objects. The word πτερύγιον is used in medical technical vocabulary to refer to both anatomical parts and diseases. In anatomy, it is applied to parts of the body that are similar and symmetrical, namely the dorsal surface of each shoulder blade transversely divided into two parts,[1] the lateral parts of the nose joining the cheeks,[2] the parts of the ears joining the temples.[3] In pathology, πτερύγιον defines a fleshy excrescence growing on the nails[4] and, as in the case examined, a disease of the eye.[5] As to the last meaning, ancient medical sources do not explain the metaphorical use of the name of the wing, but the reason is primarily the wing-like triangular shape of pterygium.[6] The Greek technical term is borrowed in Latin as ‘pterygium’[7] and corresponds to ‘unguis’ ([1]) and to the diminutive ‘ungula’ (cf. Ps.-Sor. Quaest. med. 110,2 [An. II 259,33 Rose] in oculo pterygion id est ungula).

The only graphic variant in Greek seems to be πτερύγειον in [6] and [7], whereas several variae lectiones (and corrupted forms) appear in the manuscript tradition of Latin texts and in Latin translations of Greek medical authors, such as ‘ptiringion’ (in the aforementioned Pseudo-Soranus’ item 110, drawn from the MS Cottonianus Galba E IV), ‘(p)terigium’, ‘pteria’, ‘ptiriam’, ‘pytiria’, etc.[8]

The term, joined to the stem of τέμνω, spawns three compounds of medical relevance. The verb πτερυγοτομέω, «to excise a πτερύγιον» (LSJ9 1547 s.v.), appears only once in a passage by Aëtius (VII 59,7 [CMG VIII 2, 312,29 Olivieri] ὡς ἐπὶ τῶν πτερυγοτομουμένων), while the noun πτερυγοτόμος, the instrument used to excise the pterygium, i.e. the ‘pterygotome’ or ‘pterygium knife’, has four occurrences in Aëtius (see [10])[9] and just as many in Paulus Aegineta (see [12]).[10] These compounds have evidently formed in Byzantine period, probably not prior to the VI century, as they are not attested before Aëtius. Finally, the noun πτερυγοτομία, indicating the surgical operation to remove the pterygium, seems to have a single attestation in Leo Medicus, a physician of the late IX century (cf. Syn. III 20,4 [An. med. gr. 237,20 Ermerins] καὶ κεχρήμεθα λοιπὸν τῇ πτερυγοτομίᾳ).[11]

The diminutive πτερύγιον, along with the aforementioned words for «feather» or «wing» πτερόν and πτέρυξ, are derived from the verb πέτομαι, «fly», going back to the IE root *pet / *pt, plus a suffix *r appearing also in other Indo-European languages, cf. e.g. Sk. párt-a- («wing, feather»), Lat. acci-piter, -tris («hunk»), OHG fedara and ON fiedr («feather»).[12]

To denote the eye disease, the noun πτερύγιον lives on in medical terminology of modern Greek (in form πτερύγιο)[13], as well as of other languages, which borrowed it directly from Greek or by way of Latin. Examples are: English ‘pterygium’, German ‘Pterygium’ (but the same disease is also called ‘Flügelfell’), French ‘ptérygion’, Italian ‘pterigio’.


3. Abbreviation(s) in the papyri

No abbreviated form had appeared, as yet.

[1]  Cf. Poll. II 177,2 τὰ δ' ἑκατέρωθεν ὠμοπλατῶν πτερύγια. See SKODA 1988, 29.

[2]  Cf. e.g. Poll. II 80,3-4 καὶ τὰ μὲν ἔξωθεν τοῦ σφαιρίου ἑκατέρωθεν ἀπῆναι ἢ πτερύγια; Gal. De diff. resp. I 23 (VII 820,15-6 K.) τὰ τῆς ῥινὸς πτερύγια and Introd. s. medic. 10 (XIV 17-8 K.) μυκτήρων δὲ τὰ μὲν ἔξωθεν πτερύγια. See SKODA 1988, 100-1.

[3] Cf. e.g. Poll. II 85,2-3 τὸ μὲν ἐπὶ τοὺς κροτάφους ἐπικλινὲς πτερύγιον, τὸ δὲ κάτω λοβός; Hsch. 4209, π Hansen s.v. πτερύγια· […] τοῦ ὠτὸς τὸ ἄνω. See SKODA 1988, 126-7.

[4] Cf. e.g. Cels. Med. VI 19,1-4 (CML I, 297,9-12 Marx); Dsc. I 110,12 (I 104,11 Wellmann); Paul.Aeg. VI 85 (CMG IX 2,126,24-127,21 Heiberg). See SKODA 1988, 243-5.

[5] Cf. SKODA 1988, 284-6. See also EAD. 1988b, 228-33.

[6] In addition to the similarity in shape, SKODA 1988, 285-6 mentions also a ‘functional’ reason to explain the metaphor: «(la métaphore) repose aussi sur le sème étendu: le ptérygion oculaire s’étend […], gagne du terrain, parvient jusqu’à la region de l’iris […]. On trouve ici réunis les deux aspects possible d’une métaphore, puisqu’elle est, en ce cas, à la fois descriptive et fonctionnelle».

[7] Cf. FORCELLINI, LTL IV 952 s.v. and TLL X,2 2424,49-2425,31 s.v.

[8] For a list of wrong spellings and their sources, see TLL X,2 2424,49-58 s.v.

[9]See also Id. VII 59,5, as well as 66,9 and 87,35 (CMG VIII 2, 312,27, as well as 317,19 and 333,6 Olivieri).

[10]See also Id. VI 15, 1,5, as well as 22, 1,14-5 and 23, 1,8 (CMG IX 2, 57,28, as well as 62,15-6 and 29 Heiberg).

[11] Cf.DIMITRAKOS, ΜΛ XII 6329 s.v.: «ἐγχείρησις πρὸς ἀποτομὴν πτερύγιον».

[12] Cf.CHANTRAINE, DELG II 947-8 s.v. πτερόν; FRISK, GEW II 612-3 s.v. πτερόν; BEEKES, EDG IΙ 1248 s.v. πτερόν; SKODA 1988, 243 n. 156.

[13] Cf.DIMITRAKOS, ΜΛ XII 6329 s.v. πτερύγιον 8; ΒABINIOTIS, ΛΝΕΓ 1523 s.v. πτερύγιο 3α; PAPYRAKI 1481-2 s.v. πτερύγιο 5α.

B. TESTIMONIA - A selection of representative sources

1. Hp. Prorrh. II 9-12 (IX 48,6-9 L.) – V-IV BCE

ἀχλύες, καὶ νεφέλαι, καὶ αἰγίδες ἐκλεαίνονταί τε καὶ ἀφανίζονται, ἢν μὴ τρῶμά τι ἐπιγένηται ἐν τούτῳ τῷ χωρίῳ, ἢ πρόσθεν τύχῃ οὐλὴν ἔχων ἐν τῷ χωρίῳ τούτῳ, ἢ πτερύγιον.

Mistinesses, clouds and specks become thinner and disappear, unless some other injury occurs in the part, or the person happens to have an earlier scar in the part, or a pterygium.

(Transl. P. Potter [Cambridge-London 1995] 263-5)


2. Cels. Med. VII 7,4-5 (CML I, 313,5-314,20 Marx) – I BCE-I CE

Vnguis uero, quod pterygion Graeci uocant, est membranula neruosa oriens ab angulo, quae nonnumquam ad pupillam quoque peruenit, eique officit; saepius a narium, interdum etiam a temporum parte nascitur. Hunc recentem non difficile est discutere medicamentis, quibus cicatrices in oculis extenuantur: si inueterauit iamque ei crassitudo quoque accessit, excidi debet. Post abstinentiam uero unius diei uel aduersus in sedili contra medicum is homo collocandus est, uel sic auersus, ut in gremium eius caput resupinus effundat. Quidam, si in sinistro oculo uitium est, aduersum; si in dextro, resupinum collocari uolunt. Alteram autem palpebram a ministro deduci oportet, alteram a medico: sed ab hoc, si ille aduersus est, inferiorem; si supinus, superiorem. Tum idem medicus hamulum acutum, paululum mucrone intus recuruato, subicere extremo ungui debet, eumque infigere, atque eam quoque palpebram tradere alteri; ipse hamulo adprehenso leuare unguem, eumque acu traicere linum trahente; deinde acum ponere, lini duo capita adprehendere, et per ea erecto ungue, si qua parte oculo inhaeret, manubriolo scalpelli deducere, donec ad angulum ueniat; deinde inuicem modo remittere, modo adtrahere, ut sic et initium eius et finis anguli reperiatur. Duplex enim periculum est, ne uel ex ungue aliquid relinquat<ur,> quod exulceratum uix ullam recipiat curationem; uel ex angulo quoque caruncula abscidatur; quae, si uehementius unguis ducitur, sequitur ideoque decipit: abscisa patefit foramen, per quod postea semper umor descendit: rhyada Graeci uocant. Verus ergo anguli finis utique noscendus est; qui ubi satis constitit, non nimium adducto ungue scalpellus adhibendus est, deinde excidenda ea membranula, ne quid ex angulo laedatur. Eodem inde ex melle linamentum superdandum est supraque linteolum, et aut spongia aut lana sucida; proximisque diebus deducendus cotidie oculus est, ne cicatrice inter se palpebrae glutinentur, siquidem id quoque tertium periculum accedit; eodemque modo linamentum inponendum, ac nouissime inunguendum collyrio, quo ulcera ad cicatricem perducuntur. Sed ea curatio uere esse debet aut certe ante hiemem; de qua re ad plura loca pertinente semel dixisse satis erit. Nam duo genera curationum sunt. Alia, in quibus eligere tempus non licet, sed utendum est eo, quod incidit, sicut in uulneribus [in fistulis]; alia, in quibus nullus dies urguet, et expectare tutissimum [facile] est, sicut euenit in is, quae et tarde crescunt et dolore non cruciant. In his uer expectandum est, aut si quid magis pressit, melior tamen autumnus est quam aestas aut hiemps, atque is ipse medius, iam fractis aestibus, nondum ortis frigoribus. Quo magis autem necessaria pars erit, quae tractabitur, hoc quoque maiori periculo subiecta est; et saepe, quo maior plaga facienda, eo magis haec temporis ratio seruabitur. Ex curatione uero unguis, ut dixi, uitia nascuntur, quae ipsa aliis quoque de causis oriri solent. Interdum enim fit in angulo, parum ungue exciso uel aliter, tuberculum, quod palpebras parumdeduci patitur: encanthis Graece nominatur.

An unguis too, called pterygium in Greek, is a little fibrous membrane, springing from the angle of the eye which sometimes even spreads so as to block the pupil. Most often it arises from the side of the nose, but sometimes from the temporal angle. When recent it is not difficult to disperse by the medicaments which thin away corneal opacities; if it is of long standing, and thick, it should be excised. After fasting for a day, the patient is either seated facing the surgeon, or turned away, so that he lies on his back, his head in the surgeon's lap. Some want him facing if the disease is in the left eye and lying down if in the right. Now one eyelid must be held open by the assistant, the other by the surgeon; but he holds the lower lid when seated opposite the patient, and the upper when the patient is on his back. Thereupon the surgeon passes a sharp hook, the point of which has been a little incurved, under the edge of the pterygium and fixes the hook in it; next, leaving that eyelid also to the assistant, he draws the hook towards himself thus lifting up the pterygium, and passes through it a needle carrying a thread; then having detached the needle, he takes hold of the two ends of the thread, and raises up the pterygium by means of the thread; he now separates any part of it which adheres to the eyeball by the handle of the scalpel until the angle is reached; next by alternately pulling and slackening the thread, he is able to discover the beginning of the pterygium and the end of the angle. For there is double danger, that either some of the pterygium is left behind and if this ulcerates, it is hardly ever amenable to treatment; or that with it part of the flesh is cut away from the angle; and if the pterygium is pulled too strongly, the flesh follows unnoticed, and when it is cut away a hole is left through which there is afterwards a persistent flow of rheum; the Greeks name it rhyas. Therefore the true edge of the angle must certainly be observed; and when this has been clearly determined, after the pterygium has been drawn forward just enough, the scalpel is to be used, then that little membrane is to be cut away as not to injure the angle in any way. After that, lint soaked in honey is to be put on, and over that a piece of linen, and either a sponge or unscoured wool. And for the next few days the eye must be opened daily to prevent the eyelids uniting by a scar for if that happens a third danger is added; and the lint is to be put on again, and last of all one of the salves applied which help wounds to heal. But this treatment ought to be in the spring, or certainly before winter; this warning applies to many cases, and it will be enough to give it here once for all. For there are two classes of treatment: one in which we cannot choose the time but must make the best of things, as in the case of wounds; the other in which there is no urgency and it is safest to wait, for example when the affection progresses slowly and the patient is not racked by pain. Then we should wait for spring, or if there is more urgency, autumn is better than either summer or winter, and especially mid-autumn when the hot weather has broken and the cold not yet begun. The more essential the part to be treated, the greater the danger; and often the larger the wound to be made, the more regard should thus be paid to the season. In the course of treating pterygium, lesions arise, as I have just said, which are also apt to arise from other causes. Sometimes when the pterygium has not been quite cut away or from some other cause, a small tumour, called by the Greeks encanthis, forms at the angle and this does not allow the eyelids to be completely drawn down.

(Transl. W.G. Spencer [Cambridge-London 1961] 329-33)


3. Ps.-Gal. Def. med. 366 (XIX 439,5-6 K.) – end of the I CE[1]

πτερύγιόν ἐστιν ἔκφυσις σώματος ἐπιφυομένη τῷ κερατοειδεῖ.

Pterygium is an outgrowth of tissue growing upon the cornea.


4. Gal. De tumor. praeter nat. 17,17-9 (VII 732,7-9 K.) – II CE

τὰ δὲ πτερύγια βλαστήματά ἐστι τοῦ ἐπιπεφυκότος ἔξωθεν ὑμένος τοῖς ὀφθαλμοῖς ὃς […] καταφερόμενος ἐπὶ τὴν στεφάνην ἀφικνεῖται.

Pterygia are excrescences of the conjunctiva on the surface of the eyes which […] extends and reaches the rim of the cornea.


5. Ps.-Gal. De remed. parab. II 5 (XIV 410,14-411,3 K.)

τὸ πτερύγιον νευρώδης ἐστὶ τοῦ ἐπιπεφυκότος ὑμένος ὑπεροχή· ἐκφυομένη μὲν ἀπὸ τοῦ κανθοῦ, προϊοῦσα δὲ μέχρι τῆς στεφάνης. ὅταν δὲ ὑπεραυξηθῇ, καὶ τὴν κόρην καλύπτει. τὰ μὲν οὖν μεγάλα καὶ χρόνια τῶν πτερυγίων διὰ μόνης χειρουργίας ἐκτέμνεται· τὰ δὲ νεώτερα καὶ σύμμετρα τῷ μεγέθει τὰ σμηκτικὰ δαπανᾷ, ὡς χαλκὸς κεκαυμένος ἢ χάλκανθος ἅμα χορείᾳ χολῇ.

Pterygium is a nervous excrescence of the conjunctiva arising at the canthus and advancing to the rim of the cornea. When it increases above measure, it covers the pupil itself. Therefore, large and chronic pterygia can only be extirpated by surgery, whereas the more recent and smaller ones may be worn down by the use of abstergent remedies, such as burnt copper or copper sulphate with the gall of swine.


6. P.Aberd. 11,2-20 (LDAB 4539, MP3 2342, SoSOL 2014 20) – II CE

τί̣ ἐστι ὦ̣ν̣ [τὸ πτερύγειον;] | ἔκφυσ̣ι̣ς̣ ὑμενώδης α[ὐξανομένη ἀπὸ τοῦ] | κα̣ν̣θοῦ ἢ σωματοποι̣[ουμένη] | ἀπὸ τοῦ κερατοειδοῦς [χιτῶνος.] | τίνες [εἰσὶ διαφοραὶ πτερυγείων;] | διαφέρετε αὑτῶν τ̣ό̣[πωι, μεγέθει,] | σχήματι, χρώματ[ι, φύσει ἢ ἀνα]|σκευῇ. χειρ[ουργεία τοῦ πτερυγείου.] | μετὰ τὸν καθέδρειο̣[ν ὄντα τὸν πάσχοντα, ἐκ] | τοῦ ὀφθαλμοῦ διφ[υῆ βλέφαρα διαστείλαντες] | τὸ πτερύγειον δι̣[εκφανοῦμεν ἀγκι]|στρείοι, βελόνην̣ [δὲ λίνον καὶ τρίχα ἱππείαν] | ἔ̣χο̣υ̣σ̣α̣[ν] | ]σεως  ̣ [ | ]ματι  ̣ [ | ]μεν κα̣[ | ]λ̣ε̣ιων̣  ̣ [ | ]  ̣ ν ρει δ̣[ὲ] | [  ̣  ̣ ]  ̣  ̣ ι̣ [

What is pterygium? It is a membranous excrescence growing from the canthus or taking shape from the cornea. Which are the different kinds of pterygia? They differ among themselves in location, size, shape, color, nature or healing. Surgery of pterygium. After the patient is seated, having separated the two eyelids of the eye, we will isolate the pterygium from the eye with a hook, and a needle having a thread and a horsehair.


7. P.Ross.Georg. I 20, 94-115 (LDAB 4778, MP3 2343, SoSOL 2014 473) – II CE

τεί ἐστ[ι τὸ πτερύ]|γειον; | ἔκφυσεις ὑμενώ̣[δης ἀπὸ τοῦ] | κανθοῦ ηὐ̈ξημέ[νη.] | πῶ[ς γείνεται τὸ] | π̣[τ]ε[ρύγειον;] | ἤτοι [σ]αρκὸς αὔ[ξησις τῆς] | ὑ̈πὸ τοῦ κανθο[ῦ μὲν σωματο]|ποιουμένου, γε[ίνεται δὲ καὶ] | ὑ̈πὸ τοῦ κερ̣ατ̣[οειδοῦς χιτῶ]|νος. | τ̣[είνει διαφέρουσι τὰ] | π̣[τερύγεια; | διαφέρου̣[σειν αὑτῶν μεγέ]|θει, σχήμα[τι, τόπῳ, χρωμάτει] | ἢ φύσει. | χ[ειρουργεία τοῦ] | [πτερυγείου] | διαστείλα̣[ντες τὰ βλέφαρα, τὸ] | πτερύγει[ον ἀγκίστρῳ ἐκ τοῦ] | ὀφθαλμοῦ [ἀναδεξάμενοι] | διεκφ̣αν̣[οῦμεν.]

What is pterygium? It is a membranous excrescence growing from the canthus. How does pterygium develop? It is a growth of flesh taking shape from under the canthus, but it also develops from the cornea. Which are the different kinds of pterygia? They differ among themselves in size, shape, location, color or nature. Surgery of pterygium. Having separated the eyelids, we raise and isolate the pterygium from the eye with a hook.


8. Cass. Pr. 13,3-8 (I 149,27-32 Ideler) – II-III CE ?[2]

ῥητέον οὖν, ὅτι διαφοραὶ πτερυγίων εἰσὶ δύο· ἢ γὰρ γίνεται, ὁτὲ μὲν τῆς ὑποκειμένης τῷ κανθῷ τοῦ ὀφθαλμοῦ κατὰ φύσιν σαρκὸς ἐπεκτεινομένης, ἢ ἐξ συναυξήσεως, ὁτὲ δὲ τοῦ λεπτοῦ καὶ περιτεταμένου ὑμένος περιτυλουμένου καὶ ἐξοιδαίνοντος.

It must be said that there are two types of pterygia: they occur either when the flesh naturally situated at the canthus of the eye extends increasingly, or after a growth, when the thin membrane stretching all round the eye becomes callous and swollen.


9. Orib. Eup. IV 24,12-3 (CMG VI 3, 448,1-5 Raeder) – IV CE

πτερυγίου δὲ μεγάλου μὲν ὄντος καὶ σκληροῦ γεγονότος, χειρουργίας ἐστὶν ἡ ἴασις καὶ τοῦ ἰατροῦ χρεία· τὸ δὲ μικρὸν καὶ μαλακὸν θεραπεύσεις αἰγείρου ὀπῷ μετὰ διπλασίονος μέλιτος ἐγχρίων. καὶ σηπίας δ' ὄστρακον καυθὲν καὶ μιχθὲν ἁλσὶν ἀνορύκτοις ἀποτήκει τὰ κατὰ τοὺς ὀφθαλμοὺς πτερύγια.

When pterygium is large and has become indurated, the healing is task of the surgery and the operation is physician’s duty, but you will treat small and soft pterygium with juice of black poplar, anointing it with double the amount of honey. Also the shell of sepia burnt and mixed with salt not obtained by digging reduces the pterygia on the eyes.


10. Aët. VII 60-2 (CMG VIII 2, 313,3-316,9 Olivieri) – VI CE

πτερύγιον δὲ λέγεται, ὅταν ἐπὶ πλέον αὐξηθέντος ἢ ὑπερσαρκώσαντος τοῦ ἐν τῷ ὀφθαλμῷ λευκοῦ […] ὑπεροχή τις παρὰ φύσιν ὑποστῇ. ἄρχεται δὲ τούτου ἡ αὔξησις πλειστάκις μὲν ἀπὸ τοῦ πρὸς τῇ ῥινὶ κανθοῦ τοῦ μεγάλου καλουμένου, σπανιώτερον δὲ ἀπὸ τοῦ μικροῦ, ἔτι δὲ σπανιώτερον γεννᾶται ἀπὸ τοῦ ἄνωθεν ἢ κάτωθεν βλεφάρου. ἐπεκτείνεται δὲ μέχρι τοῦ μέλανος· ὅταν δὲ μεῖζον γένηται, καὶ τῆς κόρης ἅπτεται καὶ ἐμποδίζει τὸ ὁρᾶν. εὐίατα δέ ἐστι πτερύγια τὰ λευκανθίζοντα καὶ στενὴν τὴν βάσιν ἔχοντα· τὰ δὲ ἐναντία τούτων δυσίατα. […] ἐγχειροῦμεν δὲ οὕτως πρὸς τὴν ἀφαίρεσιν τοῦ πτερυγίου· διαστέλλοντες τὰ βλέφαρα ἀπ' ἀλλήλων καὶ ἄγκιστρον καταπείροντες περὶ τὰ μέσα τοῦ πτερυγίου ἀνατείνομεν ἠρέμα, ἵνα μὴ ἡ ἐπιδερματὶς τοῦ κερατοειδοῦς μετεωρισθῇ […]. εἶτα βελόνην λαμβάνομεν λίνον ἔχουσαν διῃρημένον καὶ τρίχα ἱππείαν, καὶ ταύτην ὑποβάλλομεν τῷ πτερυγίῳ ἀναταθέντι διὰ τοῦ ἀγκίστρου· εἶτα ἀποδήσαντες τῷ ὑποβληθέντι λίνῳ τὸ πτερύγιον ἀνατείνομεν […], ἀμφοτέραις ταῖς χερσὶ κατέχοντες τὴν τρίχα διακινοῦμεν ἄνω τε καὶ κάτω, ὑποδέροντες τὸ πτερύγιον, ἀρχόμενοι ἀπὸ τοῦ μέλανος, μέχρι τοῦ κανθοῦ. εἶτα […] ἀνατείνοντες τῷ λίνῳ ἀφαιροῦμεν πτερυγοτόμῳ ἐκ τῆς βάσεως τὸ πρὸς τὸν κανθὸν μέρος τοῦ πτερυγίου, φυλασσόμενοι τὰ βλέφαρα καὶ τὸν κανθόν.

It is said pterygium when, the sclera being increased exceedingly or having formed a fleshy outgrowth, […] an unnatural excrescence occurs. Its growth mostly begins from the canthus on the side of the nose, called ‘great’, more seldom from the small one, still more rarely from the upper or lower eyelid. Pterygium can extend to the black part of the eye. Indeed, when it becomes larger, it attacks the pupil and impairs vision. Pterygia that are white and having a narrow base are easy to heal, whereas the ones opposite to these are hard to heal. […] We operate in this way for the removal of pterygium: having separated the eyelids one from the other and inserted a hook through the middle of the pterygium, we lift it up slightly, in order not to raise the skin of the cornea […]. Then we take a needle armed with a flaxen thread and a horsehair and we insert it under the pterygium raised up with the hook. Next, bound the pterygium with the thread under it, we lift it up […], and holding the horsehair with both hands we move it upwards and downwards, stripping off the pterygium from the black of the eye to the canthus. After that, […] lifting it up with the thread, we separate with the instrument called the pterygotome the part of the pterygium on the side of the canthus from its base, taking care not to injure the eyelids and the canthus.


11. Paul.Aeg. III 22,25 (CMG IX 1, 181,22-8 Heiberg) – VII CE

τὸ πτερύγιον νευρώδης ἐστὶν τοῦ ἐπιπεφυκότος ὑμένος ὑπεροχὴ ἐκφυομένη μὲν ἀπὸ τοῦ κανθοῦ, προϊοῦσα δὲ μέχρι τῆς στεφάνης· ὅταν δὲ ὑπεραυξηθῇ, καὶ τὴν κόρην καλύπτει. τὰ μὲν οὖν μεγάλα καὶ χρόνια τῶν πτερυγίων διὰ μόνης χειρουργίας ἐκτέμνεται· τὰ δὲ νεώτερα καὶ σύμμετρα τῷ μεγέθει καὶ τὰ σμηκτικὰ τῶν βοηθημάτων, οἷα τὰ τραχωματικά τέ ἐστι καὶ λευκωματικά, δαπανᾷ. ἐν ἁπλοῖς μὲν οὖν χαλκὸς κεκαυμένος ἢ χάλκανθον ἅμα χοιρείᾳ χολῇ καλῶς ποιεῖ.

Pterygium is a nervous excrescence of the conjunctiva arising at the canthus and advancing to the rim of the cornea. When it increases exceedingly, it covers the pupil itself. Therefore, large and chronic pterygia can only be extirpated by surgery. But the more recent and smaller ones may be worn down by the use of abstergent applications, such as those for trachoma and leucoma. Among the simple remedies burnt copper or copper sulphate with the gall of swine are effective.


12. Id. VI 18 (CMG IX 2, 58,16-59,4 Heiberg)

ὑμένος μὲν νευρώδους ἀπὸ τοῦ μεγάλου κανθοῦ τὸ ἐπίπαν τὴν ἀρχὴν δεξαμένου καὶ κατὰ μικρὸν ἐπὶ τὰ ἔσω ἕρποντος τοῦτο συμβαίνει τὸ πάθημα· βλάπτει δὲ τὸν ὀφθαλμὸν τῷ τε κωλύειν τῇ συνολκῇ τοῦ βολβοῦ τὴν κίνησιν καὶ τῷ προκόπτον ὅλην ἐπικαλύπτειν τὴν κόρην. εὐιατότερα οὖν ὄντα τὰ λεπτομερῆ καὶ λευκανθίζοντα χειρουργοῦμεν οὕτως· διαστείλαντες τὰ βλέφαρα τὸ πτερύγιον ἀγκίστρῳ μικροκαμπεῖ ἀναδεξάμενοι ἀνατείνωμεν, βελόνην δὲ λαβόντες ἔχουσαν κατὰ τὸ οὖς ἱππείαν τρίχα καὶ λίνον ἰσχυρὸν ἐπικαμφθεῖσάν τε μικρὸν κατὰ τὸ ἄκρον ὑπὸ τὸ μέσον τοῦ πτερυγίου καταπείρωμεν καὶ τῷ μὲν λίνῳ τὸ πτερύγιον ἐκδήσαντες μετέωρον ἀνατείνωμεν, τῇ δὲ τριχὶ τὸ πρὸς τῇ κόρῃ μέρος αὐτοῦ ὥσπερ διαπρίζοντες ὑποδείρωμεν ἄχρι πέρατος, τὸ δὲ λοιπὸν αὐτοῦ τὸ πρὸς τῷ μεγάλῳ κανθῷ ἀναρραφικῷ σμιλίῳ ἐκτέμωμεν ἐκ βάσεως καταλιμπάνοντες τὸ φυσικὸν τοῦ κανθοῦ σαρκίον […]. τινὲς δὲ τῷ λίνῳ ἀνατείναντες, ὡς εἴρηται, πτερυγοτόμῳ τὸ ὅλον ἀποδέρουσι πτερύγιον φυλαττόμενοι τοῦ κερατοειδοῦς ἅψασθαι χιτῶνος. μετὰ δὲ τὴν χειρουργίαν ὀλίγους ἅλας λείους ἐμβαλόντες εἰς τὸν τόπον ᾠοβραχὲς ἔριον ἐπιδήσομεν. μετὰ δὲ τὴν ἐπίλυσιν ἐπὶ πολὺ τὴν ἅλμην αὐτοῖς ἐνστάξομεν.

This disease (sc. pterygium) occurs by a nervous membrane having origin for the most part at the great canthus and gradually spreading inwards. It impairs the eye both by hindering the motion of the eyeball, owing to the contractions it produces, and by covering the pupil when it advances forward. Therefore, we operate upon in the following way those which are thin and white, being easier to heal: having separated the eyelids and seized the pterygium with a hook with a small curve, we stretch it, and taking a needle having a horsehair and a strong flaxen thread in its ear (i.e. eye), a little bent on the edge, we transfix it through the middle of the pterygium and, binding the pterygium with the thread, we raise it upwards, whereas, with the horsehair, we strip off and saw as it were the part at the pupil up to its extremity, but the rest of it at the great canthus we cut out from the base with the scalpel used for the operation by suture, though leaving the natural flesh of the canthus […]. But some, stretching as aforesaid with a thread, dissect away the whole pterygium with the pterygotome, being careful not to touch the cornea. After surgery, having applied some fine salt to the part, we will bind on it some wool soaked in an egg. After the removal of this we drop in the eye saltwater for a long time.

[1] For the date of this pseudo-Galenic author, an older contemporary of Galen, cf. KOLLESCH 1973, 60-6. 

[2] Cf. WELLMANN 1899, 1679-80 and KUDLIEN 1964, 1078. For a discussion on dating the Problemata by Cassius Iatrosophist, see MANETTI 2012, 423-40.


1. πτερύγιον and its medical sources

The ocular condition called πτερύγιον has been described since ancient times and it was well known long before the Greeks by the Egyptian and Indian doctors.[1] The first attestation in Greek is found in Hippocrates ([1]), which just mentions the term among other ophthalmic diseases. The earliest definition of πτερύγιον, corresponding to Latin ‘unguis’, occurs in Celsus ([2]).[2] It is described as a fibrous membrane extending from the angle of the eye to the pupil. The definition «membranula neruosa» has a correspondence in Greek expressions such as ἔκφυσις ὑμενώδης (see [6] and [7]), ὑμὴν νευρώδης (see [12]) and νευρώδης τοῦ ἐπιπεφυκότος ὑμένος ὑπεροχή (see [5] and [11]). Celsus is also the first to point out the exact localization of pterygium specifying that it arises most often from the inner (i.e. medial) canthus, the corner on the side of the nose («saepius a narium»), but sometimes even from the external (i.e. lateral) canthus («a temporum parte»), called respectively μέγας and μικρὸς κανθός in Greek sources (see [10] and [12]). Then the author focuses on the treatment (vd. infra, C 2).

Several passages of Galenic and pseudo-Galenic texts provide definitions, details on the localization and the dynamics of πτερύγιον. The use of the terms ἔκφυσις ([3]), βλάστημα ([4]) and ὑπεροχή ([5]), belonging, with slight shades of difference, to the same semantic area, confirms that πτερύγιον was considered as an «outgrowth», an «excrescence» of the external membrane of the eye. In chapter 16,1 of the pseudo-Galenic Introductio sive medicus πτερύγιον is mentioned twice among eye disorders grouped by localization, i.e., respectively, diseases affecting the angles and the white of the eye (78,6 and 9 Petit), then it is given an accurate description of it, introduced by a temporal clause: a πτερύγιον occurs when, after ulceration and excessive growth of the white of the eye, a thin and nervous membrane spreads over the surface from one of the angles to the pupil (ibid. 16,6 [82,2-6 Petit] πτερύγιον δὲ λέγουσιν, ὅταν ἐπὶ πλέον ἑλκωθέντος καὶ ὑπερσαρκώσαντος τοῦ λευκοῦ ὑμὴν λεπτὸς καὶ νευρώδης ἐπιδράμῃ τὸν ὀφθαλμὸν, ἀρξάμενος ἀπό τινος τῶν κανθῶν, ἕως τοῦ μέλανος καὶ τῆς κορυφῆς ἐφάψηται). In such a case pterygium can obstruct vision, as it is said elsewhere (see Gal. De differ. morb. 8,8-11 [VI 862,12-5 K.] ἔσται δὴ καὶ τούτων αὐτῶν τὰ μὲν νοσήματα, καθάπερ τὸ πτερύγιον, [ἐμποδίζει γὰρ, ὅταν ἱκανῶς αὐξηθῇ, τὴν ὄψιν, ἐπισκοτοῦν τῇ κόρῃ] κτλ.).

In the Problemata by Cassius Iatrosophist (13 [I 149,25-150,2 Ideler]), the author inquires why pterygia are especially common among sailors and people working on the sea (διὰ τί ἐπὶ τῶν θαλαττουργῶν μάλιστα ἐπιπολάζει τὰ πτερύγια; γίνεται μὲν γὰρ καὶ ἐν ἄλλοις, ἐπιπολάζει δὲ ἐπὶ τῶν κατὰ τὴν θάλατταν ἐργαζομένων). So, an environmental factor is explicitly identified as a cause of pterygium (see infra). Then follows a double definition of the disease according to the portion of the eye where it forms (see [8]): a first kind of pterygium involves the tissue naturally located in the angle of the eye, whereas the second kind is represented by an abnormal growth of the cornea. This is likely the most serious one, as it is said that the membrane becomes callous and swollen. Finally, a further (morphological) distinction is made between pterygia «that are fastened» and pterygia «that are like united» (ibid. [I 150,1-2 Ideler] ἴσμεν δέ, ὅτι δύο διαφοραί εἰσι πτερυγίων·καὶ τὰ μέν ἐστι προσηρτημένα, τὰ δὲ ὥσπερ συμπεφυκότα).

Among Greek medical authors, the most extensive and elaborate discussion on pterygium is found in Aëtius ([10]). The discussion is divided into three sections devoted, respectively, to: 1) a general, albeit detailed, introduction to πτερύγιον, including description, localization, dynamincs of the disease (VII 60 [CMG VIII 2, 313,3-24 Olivieri]); 2) pharmaceutical therapy (ibid. 61 [ibid., 313,25-315,8 Olivieri]); 3) surgery (ibid. 62 [ibid., 315,9-316,9 Olivieri]). The first section recalls, though more in depth, what already said by previous physicians and its beginning closely resembles the aforementioned pseudo-Galenic passage in phrasing, word choice and sentence structure. The author remarks that pterygium, defined as «an unnatural excrescence» (ὑπεροχή τις παρὰ φύσιν) spreading from one of the canthi, or even from the upper or lower eyelid, to the pupil, can, in this case, impair vision, so that it must be removed by surgery, whereas, when small and white, it can be reduced by pharmacological treatment (see ibid. 60,16-22 [ibid., 313,18-24 Olivieri] τὰ δὲ μέχρι τῆς κόρης διήκοντα καὶ διὰ τοῦτο παραποδίζοντα τὸ ὁρᾶν, ἀφαιρούμενα ἐλευθεροῖ μὲν τὸν ὀφθαλμὸν τῶν ῥευματισμῶν. ἡ δὲ ἐπιγιγνομένη περὶ τὴν κόρην ἐκ τῆς χειρουργίας οὐλὴ οὐδὲν ἧττον κωλύει τὸ βλέπειν. τῶν δὲ πτερυγίων ταῦτα χειρίζειν δεῖ, ὅσα αὐξηθέντα ἐπιβάλλει τῷ μέλανι· ὅσα δὲ μικρὰ καὶ ἐπὶ τοῦ λευκοῦ ἐστι, ταῦτα φαρμάκοις πειρᾶσθαι καταστέλλειν).

Accounts on pterygium preserved by other Byzantine compendiasts and later writers respond well to the traditional theory outlined so far. They differ among themselves in terms of length and phraseology, but are very similar from a medical point of view. An excellent example is Paulus Aegineta (see [11] and [12]), as well as, among the others, Leo Medicus (IX century),[3] Theophanes Nonnos (X century)[4] and Johannes Actuarius (XIII-XIV century).[5]

In late antiquity and in the early medieval period Arab and Persian physicians continued to pass on the writings of Greek authors. For instance, Ali Abbas describes the disease very accurately and recommends bleeding, purging and the application of a variety of salves. A similar account is found in Alsaharavius, who specifies that, when pterygium becomes nervous, it must be treated by surgery. Other authors, such as Jesu Haly and Rhazes, recommend escharotic remedies before attempting a surgical operation.

Two medical catechisms on papyrus, both dating back to the II century CE, P.Aberd. 11 ([6]) and P.Ross.Georg. I 20 ([7]),[6] deals with πτερύγιον following the usual question-answer format. The last one contains remains of three columns discussing four eye diseases (col. II rr. 55-67 γλαύκωμα, rr. 68- 93 σταφύλωμα, rr. 94-115 πτερύγιον, col. III rr. 116-25 ῥευματισμός), whereas P.Aberd. 11 preserves less than 20 readable lines on πτερύγιον and overlaps with P.Ross.Georg. I 20 in its discussion. However, despite several textual similarities, neither papyrus seems to be a copy of the other. First of all, they differ in the number of sections, since [7], after the definition, continues with a question about etiology (rr.98-104 πῶ[ς γείνεται τὸ] | π̣[τ]ε[ρύγειον;] | ἤτοι [σ]αρκὸς αὔ[ξησις τῆς] | ὑ̈πὸ τοῦ κανθο[ῦ μὲν σωματο]|ποιουμένου, γε[ίνεται δὲ καὶ] | ὑ̈πὸ τοῦ κερ̣ατ̣[οειδοῦς χιτῶ]|νος), while [6], instead of the new question, produces a longer definition including information offered by [7] as etiology and localization, i.e. the mention of the cornea as a part of the eye from which pterygium can grow (rr.4-5 σωματοποι̣[ουμένη] | ἀπὸ τοῦ κερατοειδοῦς [χιτῶνος]). Thus, on the one hand [6] concentrates the mention of both the canthus and the cornea in a sort of ‘double definition’ that might be compared to [8]; on the other, [7] repeats the mention of the canthus in the second answer and adds that of the cornea. It is noteworthy the juxtaposition ἔκφυσις ὑμενώδης that both papyri employ to define pterygium. This expression is never applied to πτερύγιον in medical authors,[7] but its appearance in these papyri might suggest that ἔκφυσις ὑμενώδης, «membranous excrescence», was the traditional definition of πτερύγιον in catechistic texts. The noun ὑμήν, «membrane», is often associated with πτερύγιον, but it is rather juxtaposed with νευρώδης, «nervous», such as in [12], or it is found in the phrase νευρώδης τοῦ ἐπιπεφυκότος ὑμένος ὑπεροχή, such as in [5] and [11], as aforesaid. Differently, the meaning of «excrescence» is expressed here by ἔκφυσις, that is the term used in the pseudo-Galenic Definitiones medicae ([3]). The papyri indeed begin discussion of pterygium in a manner resembling that in [3], particularly [6], since both [3] and [6] subsume mention of the cornea in the definition. The following question inquires about the types of pterygia and the response outlines differences in size, shape, location and color. The differentiation criteria correspond to those that will be more extensively recorded in Aëtius (see [10]). Finally, both papyri conclude with surgical treatment (vd. infra, C 2). All in all, it can be said that what is reported in the catechisms reflects «the traditional theory over the longue durée from Celsus and Galen to Johannes Actuarius».[8]

The lexical continuity, supported by the analysis of Greek and Latin sources, confirms that ancient concept of pterygium is nearly the same as in modern ophtalmology. In modern terms, pterygium is described as a wing-shaped growth of fibrovascular tissue that originates on the perilimbal conjunctiva. This overgrowth covers the sclera, the white part of the eye, and can progressively encroach onto the corneal surface. If pterygium extends over the pupillary aperture it can interfere with vision, but it may also distort the corneal topography causing astigmatism and blurred vision. In most cases, pterygium develops on the nasal limbus, the inner canthus, but it may sometimes grow from the outer corner (the external canthus) or on both sides at the same time. It may affect one or both eyes; in the latter case, it is called a bilateral pterygium. A pterygium consists of three distinct parts: the cap, a flat zone on the cornea; the head or apex, a vascular area that lies behind the cap and is firmly attached to the cornea; the body or tail, a mobile area of the bulbar conjunctiva. Early in the disease process, pterygium is usually painless, but an enlarging pterygium may cause irritation and redness. The main symptom is a fleshy, raised area often containing hyperemic blood vessels. Other symptoms may include congestion, itching and burning, foreign body sensation, photophobia, tearing and decreased visual acuity. The exact etiology of pterygium is yet to be determined, so that it is still considered as «an ophthalmic enigma».[9] It has long been accepted that some environmental factors, such as wind, dust and low humidity, are significant risk factors for the development of pterygium, but it has also become clear that prolonged exposure to ultraviolet (UV) rays is the most important environmental influence.[10] Pterygium is found in all parts of the world, but its incidence increases in populations living near the equator, in subtropical and tropical climates.[11] A “pterygium belt” has been mapped within the 30th parallels.[12] This geographic distribution, marked by decreased incidence in the upper latitudes and increased rates of occurrence in lower latitudes, seems to confirm the current concepts in pterygium pathogenesis, which emphasize the role of infrared radiation from sunlight. Pterygium is also very common in people who spend a lot of time in occupations that require outdoor activities, such as farmers, fishermen and sailors, a fact already stressed in ancient times by Cassius Iatrosophist (see supra). Furthermore, its prevalent occurrence in sunny and arid locations may contribute to explain the interest devoted to it by the questionnaires on papyrus coming from Egypt.[13]


2. πτερύγιον in practice

Ancient medical sources insist on the fact that small and recent pterygia may be treat with remedies, whereas enlarged and indurated pterygia must be extirpated by surgery (see [2], [5], [9] and [11]):[14] surgical removal of pterygium is in fact the only choice of treatment once salves and other medicaments have failed. As to the former case, the smallest pterygia are reduced by abstergent applications, such as burnt copper or copper sulphate with the gall of swine (see [5] and [11]). Other effective remedies are juice of black poplar with honey and burnt sepia bone mixed with salt (see [9]).[15] Salt is indeed often used in eye salves and plasters because of its astringent, cleansing and reducing power.[16] Among the other most active ingredients are sal ammoniac, cadmia, gall, saffron, arsenic and magnesian stone. Prescriptions for a variety of medications are recorded by many authors. Aëtius devotes an entire chapter to a long list of remedies (VII 61 [CMG VIII 2, 313,25-315,8 Olivieri]) and several recipes are found, for instance, in Pliny the Elder,[17] Galen (and Pseudo-Galen),[18] Alexander of Tralles[19] and Theophanes Nonnos.[20]

Greek and Latin physicians give excellent accounts of surgery for pterygium. The most complete and detailed descriptions of the surgical procedures are preserved by Celsus ([2]), Aëtius ([10]) and Paulus Aegineta ([12]). Celsus ([2]) is the first among the Greco-Roman medical writers to deal systematically with eyelid surgery and in particular with pterygium removal. The Roman author is extremely methodical in describing every step of the operation. The techniques reported by Celsus strictly resemble those described in the Sanskrit text entitled ‘Sushruta Samhita’, an encyclopedic volume written by the Indian surgeon Sushruta in the VI century BCE. These close similarities have led to the hypothesis that, in the case of ophthalmologic surgery, Celsus knew a source that described Indian surgical practices.[21] According to Celsus, the patient can either be seated facing the surgeon or can be laid down on his back. The first way is preferable when the pterygium is in the left eye, the second in the right. Then, with the eyelids held wide apart by the surgeon and his assistant, the pterygium is grasped with a sharp hook somewhat bent at the extremity and a threaded needle is passed below it. Finally, the surgeon excises the pterygium at its base raising it up and cutting out the membrane, so separated from the eyeball, by means of a scalpel. Only an adequate excision prevents any recurrence, as well as the onset of a tumor called ἐγκανθίς in the inner angle of the eye. The post-operative management includes the application of a lint soaked in honey and either a sponge or some wool over it. In the next few days proper salves must be used to help wounds to heal. Finally, Celsus recommends spring or mid-autumn as the best seasons to perform the operation since the temperature is neither too hot nor too cold.

Apart from a brief mention in the pseudo-Galenic Introductio sive medicus, in which it is said that both πτερύγια and εγκανθίδες are lifted up either with a thread or a hook (19,6 [93,3-7 Petit] τὰς δὲ ἐγκανθίδας καὶ πτερύγια καὶ τὰ σταφυλώματα περιαιροῦμεν, τὰ μὲν σταφυλώματα λίνον διείραντες καὶ ἀποβροχίζοντες, τὰ δὲ πτερύγια καὶ τὰς ἐγκανθίδας ἢ λίνῳ ἀνατείναντες, ἢ ἀγκίστρῳ), Aëtius is the first Greek author to extensively describe the procedures for pterygium removal (VII 62 [CMG VIII 2, 315,9-316,9 Olivieri], see [10]). In general, the description resembles in part that of Celsus, but Aëtius adds the use of a horsehair to be inserted under the pterygium previously lifted up with a hook. Then, pterygium is stripped off moving the horsehair upwards and downwards. A tool specifically created to dissect away the pterygium has its first attestation in Aëtius, the πτερυγοτόμος or «pterygium knife» (see infra): in this passage it is properly used to separate the part of the pterygium on the side of the canthus from its base, care being taken not to injure the eyelids. The base must be adequately excised in order to prevent recurrence (VII 62,17-8 [CMG VIII 2, 315,25-6 Olivieri] εἰ δὲ ἡ βάσις τοῦ πτερυγίου καταλειφθῇ, παλιγγενεσία γίγνεται). Aëtius’ discussion is concluded with the post-operative treatment (ibid. 62,22-8 [CMG VIII 2, 316,3-9 Olivieri]). After the removal the author recommends moistening the eye with pungent saltwater (μετὰ δὲ τὴν ἀφαίρεσιν ἅλμῃ δριμυτέρᾳ δέον ἐγχυματίζειν τὸν ὀφθαλμόν), and prescribes a variety of collyria for the following days: first those of a mild kind, such as the ἀπαλοί, then, the fourth day, collyria unmixed and able to promote the growth of flesh (τὰ ἁπλᾶ καὶ σαρκωτικὰ κολλύρια), such as the ones made of nard and wine (τὰ νάρδινα καὶ τὰ Θεοδότια καὶ τὰ δι' οἴνου πάντα).

Paulus Aegineta ([12]) describes the operation in terms quite similar to Aëtius’, but he introduces a double option: with or without the πτερυγοτόμος. The latter involves, as usual, a hook, a needle threaded with a horsehair and a flaxen thread, and a scalpel: the pterygium is raised by the small sharp hook, the needle carrying the horsehair and a strong flaxen thread is passed under it, then the surgeon saws off the pterygiun towards the apex by means of the horsehair, severing its base with the scalpel. The other method consists in dissecting away the pterygium, stretched with the thread, with the pterygotome. The fact that this is considered as an alternative choice is pointed out by τινές followed by adversative δέ, i.e. «but some (other surgeons) etc.». Like Celsus and Aëtius, also Paulus provides post-operative instructions recommending the application of some wool dipped in an egg and the prolonged use of saltwater.

Among Arab and Persian physicians, Albucasis describes the same procedure as Aëtius warning not to carry the incision too near the inner canthus. Haly Abbas, Rhazes and Avicenna prefer the use of the scissors to the scalpel, whereas Jesu Haly approves both the scalpel and a pair of scissors.

Surgery is the last topic in the two catechisms ([6] and [7]). The corresponding portion of sheet is badly damaged in both papyri and, despite the loss is extensive, restorations of lacunae depend upon the descriptions in Celsus, Aëtius and, mainly, in Paulus.[22] According to the surgical procedure described by these authors, the eyelids are drawn aside certainly in [7] (l.112 διαστείλα̣[ντες τὰ βλέφαρα), likely in [6] (l.11 τοῦ ὀφθαλμοῦ διφ[υῆ βλέφαρα διαστείλαντες]), since the adjective διφυής, «double», albeit partially restored, seems to be applied to the two eyelids. Then the pterygium is isolated from the eyeball with a hook, probably with a view toward removal: see [6] ll.12-3 τὸ πτερύγειον δι̣[εκφανοῦμεν ἀγκι]|στρείοι and [7] ll.112-5 τὸ] | πτερύγει[ον ἀγκίστρῳ ἐκ τοῦ] | ὀφθαλμοῦ [ἀναδεξάμενοι] | διεκφ̣αν̣[οῦμεν, where both the context and the word choice seem to assure the presence of ἄγκιστρον in the lacuna. [6], increasingly damaged after l.13, includes procedural information additional to that in [7]: the patient is seated (cf. μετὰ τὸν καθέδρειο̣[ν ὄντα τὸν πάσχοντα, l.10, see s.v. καθέδριος), like in Celsus (aduersus in sedili contra medicum is homo collocandus est), and the usual needle threaded with a thread and a horsehair is used in addition to the hook (ll.13-4 ἀγκι]|στρείοι, βελόνην̣ [δὲ λίνον καὶ τρίχα ἱππείαν] | ἔ̣χο̣υ̣σ̣α̣[ν]).

In summary, the surgical implements ordinarily employed in pterygium surgery are: the sharp hook bent et the extremity (hamulus, ἄγκιστρον) to seize and raise up the pterygium for excision;[23] the needle (acus, βελόνη);[24] the thread (linum, λίνον);[25] the horsehair (θρὶξ ἱππεῖα);[26] the scalpel (scalpellus, σμιλίον) to cut out from the base the pterygium after it has been drawn forward;[27] the pterygotome (πτερυγοτόμος).[28] This special knife, made firstly for this purpose – dissecting away the base of a pterygium –, was also used for other eye operations. Thus, it was employed to free the adhesion of the eyelids,[29] as well as to sever the outgrowths from the white of the eye[30] and to operate the fistula lachrymalis dissecting out the part between the lachrymal sac and the canthus.[31] A further use is in excision of aural polyp, a membranous growth in the outside ear canal.[32] As to its material aspect, the pterygotome was likely a narrow, slender, sharp-pointed blade mounted on a small scalpel handle as it was depicted by Albucasis to accompany the passage by Paulus on pterygium.[33] Since the compound πτερυγοτόμος has no attestation before Aëtius (VI century CE) and there is no mention of such an instrument in the accurate description of pterygium surgery in Celsus, it seems highly probable that both the term and the corresponding object are a late invention. So, considering the double option in Paulus, the one without the pterygotome might reflect the older and traditional method, whereas the one with the pterygotome might represent a more modern and innovative procedure. On the archaeological ground, this impression is strengthened by the change in the shape of surgeons’ knives that appears to be from the III century CE onwards, with the increased use of smaller blades and longer and more slender handles: several tiny blades found in medical context may indeed be identified with the pterygotome advocated by Aëtius and Paulus and figured by Albucasis.[34]

In modern times there is a lack of consensus on the most appropriate medical and surgical management of pterygia.[35] Since early pterygia are asymptomatic, they do not require treatment, but when a worsening of the inflamed condition causes a dry eye feeling, redness, and irritation, the therapy involves lubricating medications, such as artificial tears or ointments, occasional use of vasoconscrictor eyedrops, or steroid eyedrops. If the lesion grows, surgical intervention becomes more compelling. Numerous surgical approaches have been attempted and a variety of options are available today. Recurrence is the main challenge to successful pterygium treatment and a long-term follow up is necessary as pterygium may recur even after surgical removal. Anyway, regardless of the technique chosen, excision is the first step for repair. The most often performed surgery is called pterygium excision with conjunctival autografting (PECG). In this procedure, after the pterygium is carefully dissected away, a tissue graft, usually harvested from the temporal bulbar conjunctiva, is transplanted to the bare sclera and is fixated into the bed of the excised pterygium using sutures, tissue adhesive, or glue adhesive. An alternative tecnique involves an amniotic membrane graft to cover the exposed sclera. Given the high recurrence rates associated with surgery, several adjunctive therapies, such as Mitomycin C (MCC) and beta irradiation, have been incorporated into the management of pterygia.

[1] Cf. ROSENTHAL 1953, 1601-16; LAZZERI et al. 2012, 162-3 and 165.

[2] Cf. SCHELLER 1906, 376-8.

[3] Cf. Syn. III 20 (An. med. gr. 237,15-25 Ermerins) πτερύγιόν ἐστιν ὑπερσάρκημα τοῦ ἐπιπεφυκότος ὑμένος ἀρχόμενον ἐκ τοῦ μεγάλου κανθοῦ καὶ ἐξαπλούμενον μέχρι τῆς κόρης, ὅθεν ἐπειδὰν αὐξηθῇ σκοτίζει αὐτήν· καὶ κεχρήμεθα λοιπὸν τῇ πτερυγοτομίᾳ, βελόνῃ ἐμβάλλοντες τρίχα ἵππου καὶ οὕτως πρίζοντες καὶ λοιπὸν τοῖς κατασταλτικοῖς κολλουρίοις κεχρήμεθα καὶ λεπτοῖς, οἷον τὸ Κωνσταντίνου καὶ τὸ διὰ κέρατος ἐλαφίου, καὶ τὸ διὰ κογχύλης. γίνεται δὲ πτερύγιον σπανιάκις καὶ ἀπὸ τοῦ μικροῦ κανθοῦ.

[4] Cf. Epit. LXIII (I 240,5-10 Bernard) πτερύγιόν ὑπερσάρκωμα ἐστι τοῦ ἐπιπεφυκότος ὑμένος, ἀρχόμενον ἐκ τοῦ μεγάλου κανθοῦ, καὶ ἐφαπλούμενον μέχρι τῆς κόρης κτλ.

[5] Cf. De diagn. II 7,118-22 (II 447,9-13 Ideler) τοῖς τῶν ὀφθαλμῶν δὲ πάθεσι καὶ τὸ πτερύγιον συγκαταλεγόμενον, τοῦ ἐπιπεφυκότος ὑμένος ὑπεροχὴ νευρώδης ἐστίν, ἣ ἀπὸ τοῦ κανθοῦ ἰοῦσα μέχρις αὐτῆς στεφάνης χωρεῖ, ἄν γε μὴ ὑπεραυξηθὲν τὸ πτερύγιον τύχῃ, καὶ τὴν κόρην αὐτὴν ἐπικαλύπτοι καὶ τοῦ ὁρᾷν κωλύει.

[6] The relationship between these two catechisms was first pointed out by MARGANNE 1978, 313-20, who republished them in MARGANNE 1994, 104-11 (P Aberd. 11) and 112-32 (P.Ross.Georg. I 20). P.Aberd. 11, mentioned by WINSTEDT 1907, 266 and OLDFATHER 1923, 22 no. 359 as a fragment of a «metrical treatise», was finally recognised as a medical papyrus «perhaps on the eye» by TURNER 1939, 13 and KÖRTE 1941, 145 no. 1017. For previous editions, corrections and bibliography on both, see MARGANNE 1981, 35 and 266, as well as EAD. 1978, 313 nn. 3-6 and 315 n. 2, and 1994, 104 and 112. Another questionnaire dating back to the IV century CE, P.Strasb. gr. inv. 849 (LDAB 10299, MP3 2343.01, SoSOL 2011 482), published by MAGDELAINE 2004, 63-77, is specialized in ophtalmology and forms «un ensemble cohérent» with P.Aberd. 11 and P.Ross.Georg. I 20.

[7] But see the definition πτερύγιον ὑμενῶδες in Hippiatr. Berol. XI 39,8 (I 70,5 Oder-Hoppe).

[8] HANSON 2003, 207. See also MARGANNE 1978, 320 and 1994, 111 and 128-9.

[9] Cf. COSTER 1995, 304-5 with references.

[10] On pterygium in general, but especially on its etiology and pathogenesis, see e.g. KAMEL 1954, 682-8; ELLIOT 1961, 22-41; TAYLOR 1982, 1698; MORAN-HOLLOWS 1984, 343-6; THRELFALL-ENGLISH 1999, 280-7; CORONEO-DI GIROLAMO-WAKEFIELD 1999, 282-8; SAW-TAN 1999, 219-28; SOLOMON 2006, 665-6; TODANI-MELKI 2009, 21-30.

[11] Cf. e.g. SINGH 1990, 542-3; WIWANITKIT 2009, 7.

[12] Cf. e.g. ANDERSON 1954, 1631-42.

[13] Pterygium was probably one of the most important topics in ancient ophthalmology. See ANDORLINI 2004, 184: «i questionari medici dei papiri affrontano le problematiche fondamentali per l’insegnamento, come l’importanza della conoscenza di una terminologia medica approppriata, le questioni cruciali di oftalmologia relative a fenomeni quali stafiloma, pterigio, cataratta».

[14] See also, e.g., Gal. De meth. med. XIV 19,14-20 (X 1018,12-1019,1 K.) τὸ γάρ τοι πτερύγιον ὅτι μὲν ἀλλότριόν ἐστι τῆς ὑγιεινῆς καταστάσεως εὔδηλον εἶναι νομίζω πᾶσιν· οὐ μὴν ἀλλότριόν γε κατὰ τὴν οὐσίαν ἐστὶν, ὥσπερ ἀθέρωμα καὶ μελικηρίς. ἴασις δὲ καὶ τούτου μικροῦ μὲν ὄντος ἔτι καὶ μαλακοῦ διὰ τῶν ῥυπτόντων φαρμάκων, οἷά πέρ ἐστι καὶ τὰ τραχωματικὰ καλούμενα· μεγάλου δὲ καὶ σκληροῦ γενομένου διὰ χειρουργίας. Cf. MARGANNE 1994, 107: «lorsque le ptérygion est invétéré et épais, le chirurgien doit l’exciser, mais, quand il est récent, on le soigne par des médicaments».

[15] The latter is also prescribed, e.g., by Plin. Nat. XXXII 72,1-2, Gal. De simpl. med. fac. XXX 27,7-8 (XII 347,16-7 K.) and Aët. VII 61,10-1 (CMG VIII 2, 314,4-5 Olivieri).

[16] See e.g. Dsc. MM V 109, 2,1-10 (III 80,4-10 Wellmann) δύναμιν δὲ ἔχουσι κοινῶς οἱ προειρημένοι ἅλες ὄντες πολύχρηστοι στυπτικήν τε καὶ σμηκτικὴν καὶ ἀποκαθαρτικὴν καὶ διαχυτικήν […]. στέλλουσι καὶ τὰς ἐν ὀφθαλμοῖς ὑπεροχὰς καὶ πτερύγια τήκουσι, καὶ τὰς ἄλλας δὲ ὑπερσαρκώσεις and Plin. Nat. XXXI 99,6-8 (sc. sal) item oculorum remediis et ad excrescentes ibi carnes totiusque corporis pterygia, sed in oculis peculiariter, ob id collyriis emplastrisque additus.

[17] Cf. e.g. Nat. XXIII 9,4-5 (ash of oenanthe, a product of the wild vine) and 108,1-3 (medicine called stomatice made from the bitter pomegranate); XXVIII 171,3-6 (gall of goat with wine); XXXIV 105,1-3 (cadmia).

[18] Cf. De simpl. med. fac. VI 3, 9,12-4 (XI 858,13-5 K.) and VIII 7,17 (XII 142,5 K.); De comp. med. sec. loc. III 4 (XII 717,7-10 K.); De comp. med. per gen. V 13 (XIII 838,13-839,1 K.) and 15 (XIII 858,5-7 K.); Ps.-Gal. De remed. parab. I 5 (XIV 350,3-4 K.) and II 5 (XIV 411,1-6 K.).

[19] Cf. e.g. II (II 47,4-13, as well as 51,27-53,15 and 65,27-67,3 Puschmann).

[20] Cf. Epit. LXIII (I 240,7-10 Bernard).

[21] This aspect has been discussed by LAZZERI et al. 2012, 162-7.

[22] See especially OLIVIERI 1928, 245-7; MARGANNE 1994, 111 and 129; HANSON 2003, 207.

[23] Cf. MILNE 1907, 85-7; JACKSON 1987, 407; MARGANNE 1987, 407 and 1994, 129 n. 31 with references; GHIRETTI 2010, 72-3.

[24] Cf. MILNE 1907, 69-71 and 74-5; JACKSON 1987, 415; MARGANNE 1987, 408-9; GHIRETTI 2010, 73-5.

[25] Cf. GHIRETTI 2010, 86.

[26] Cf. MILNE 1907, 162; GHIRETTI 2010, 72.

[27] Cf. MILNE 1907, 27-8 and 45; JACKSON 1987, 415; GHIRETTI 2010, 61-3.

[28] Cf. MAGNUS 1901, 657-8; MILNE 1907, 44-6; MARGANNE 1978, 319 and 2004, 129 with n. 35; GHIRETTI 2010, 73; JACKSON 2014, 140.

[29] Cf. Aët. VII 66,9 (CMG VIII 2, 317,19 Olivieri) and Paul.Aeg. VI 15, 1,5 (CMG IX 2, 57,28 Heiberg).

[30] Cf. Aët. VII 59,5 (CMG VIII 2, 312,27 Olivieri).

[31] Cf. Aët. VII 87,35 (CMG VIII 2, 333,6 Olivieri) and Paul.Aeg. VI 22, 1,14-5 (CMG IX 2, 62,15-6 Heiberg).

[32] Cf. Paul.Aeg. VI 23, 1,8 (CMG IX 2, 62,29 Heiberg).

[33] See MILNE 1907, Pl. IX, fig. 2.

[34] See JACKSON 2014, 140 also for reference to concrete specimina.

[35] See e.g. KAMEL 1954, 682-8; HOFFMANN-POWER 1999, 15-26; ANG-CHUA-TAN 2007, 308-13; AMINLARI-SINGH-LIANG 2010, 37-8; BARRAQUER-CHAROENROOK 2013, 51-60; GUTIERREZ-MEJIA 2013, 35-49.


1. Lexicon entries

ThGL VII 2172B-2173C s.v.; TLL X,2 2424,49-2425,31 s.v. pterygium; FORCELLINI, LTL III 952 s.v. pterygium; LSJ9 1547 s.v.; CHANTRAINE, DELG II 947-8 s.v. πτερόν; FRISK, GEW II 612- s.v. πτερόν; BEEKES, EDG II 1248 s.v. πτερόν


2. Secondary literature

SCHELLER 1906, 376-8; OLIVIERI 1928, 244-7; MARGANNE 1978, 314-5 and 319-20, as well as EAD. 1987, 407, and 1994, 105-11 and 128-9; PENSO 1985, 400 and 485; SKODA 1988, 29, 100-1, 126-7, 243-5, 284-6; ANDRÉ 1991, 42 and 153; HANSON 2003, 205-7; ANDORLINI 2004, 223; GHIRETTI 2010, 72-3

E. CPGM reference(s)

P.Aberd. 11,2 as well as 6, 9 and 12 – SoSOL 2014 20.

P.Ross.Georg. I 20,94-5 as well as 99, 106, 11 and 113 – SoSOL 2014 473.


Isabella Bonati

Accepted term: 28-Ago-2015