Purpose: Pterygium is a benign growth of conjunctival tissue frequently related to chronic sunlight exposure and hot and dry climate. Purpose of this study was to evaluate the predominant symptoms in patients with pterygium leading to its surgical removal decision. Methods: 31 patients (19 males, 12 females), mean age 48.75 years old (SD 8.5), with primary pterygium and no other eye disease participated in the study. The predominant symptoms caused by the pterygium were assessed using a questionnaire. Results: The predominant symptoms associated with the pterygium were: discomfort/feeling of foreign body in 31 patients (100%), redness in 23 (74%), increased lacrimation in 17 (55%), aesthetic reasons in 12 (39%), visual disturbance (astigmatism/extension of the pterygium to the optical axis) in 4 (13%). In one case, despite the absence of annoying symptoms, surgical excision was proposed due to the atypical appearance of pterygium. For younger patients, the predominant reason for choosing surgical removal was that the patients are not content with external appearance caused by pterygium and in contrast lacrimation was the predominant reason for the older. In most patients, visual disturbance was not a significant cause although astigmatism in eyes with pterygium was 3.51 D (SD 1.82) and 0.95 D (SD 0.78) in healthy eyes respectively. Discussion: The main symptom in patients with pterygium is foreign body sensation; meanwhile aesthetic consideration and increased lacrimation are the main reasons leading to surgical removal decision for younger and older patients, respectively.