Recurrent pterygia are aggressive! They tend to encroach deeper in the cornea and pull more conjunctiva from the fornices. Which in turn may produce slight ptosis, and bigger corneal scars. Cases of ptosis in recurrent pterygia, however, are rare in the literature (and, in the real life).
This patient has come with complaints of pain in the eye, and also complained, that eye has become smaller. He underwent initial pterygium excision in the same eye few months back, and afterwards – he had pyogenic granuloma excision. He obviously has upper lid ptosis in left eye. What is not obvious, however, is the retraction of the upper lid in contralateral eye. This is how Hering’s law works for the eyelids. Unilateral ptosis may contribute to contralateral upper lid retraction.
I would opt for the conjunctival autograft in this case (probably with sutures), to avoid future even more aggressive recurrences and at the same time – to expand upper fornix and relieve ptosis.