Pinguecula occur on the conjunctiva when sun damage has occurred. This may be from UV damage that has occurred even from our childhood. While the conjunctiva tissue fundamentally changes, a pinguecula is NOT considered pre-cancerous! You can consider it to be similar to sun spots that occur on the skin as we age---these are also not pre-malignant. Sometimes they can get red and inflamed, but they typically don’t cause any significant symptoms and do not require treatment. Sometimes they can get extremely raised and irritable, but generally the only indication for removal is cosmesis.
In the setting of chronic inflammation (e.g. dry eye, demodex blepharitis), pinguecula can become red and inflamed and grow onto the cornea. When the growth reaches the cornea, it is called a pterygium. Treating dry eye and any demodex infection can help slow the progression, but surgical excision is the only way to address it permanently. Surgical indications by insurance standards include pain, induced astigmatism, threatening the visual axis and double vision (rarely in recurrent pterygia). This can also be removed as a cosmetic procedure. Since removing the pterygium and leaving a scleral defect usually results in a 50% chance of recurrence, Dr. Raja normally uses either amniotic membrane or a conjunctival autograft. This gives a much less risk of recurrence and a much better cosmetic result.