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To measure the incidence and evaluate the clinicopathologic characteristics, surgical outcome, and prognosis of conjunctival granulomas (CGs) after pterygium surgery.This was a retrospective review of 3851 pterygium eyes (3330 patients) that underwent pterygium surgery from March 2004 to May 2017. The outcomes were evaluated in 52 eyes (50 patients) that developed CGs after pterygium surgery.CGs developed in 52 of 3851 operated pterygium eyes (1.4%) over a 13-year period. Mean patient age was 54.4 ± 9.9 years (range, 28–72 years). The mean onset time of the CG after pterygium surgery was 42.8 ± 18.3 days (range, 12–90 days). The location of the granulation was around the free conjunctival flap. Histopathologic examination showed inflammatory granulation tissue with large amounts of inflammatory cell infiltration. All CGs were successfully cured by surgical excision combined with corticosteroid eye drops. No patient had recurrence at a mean follow-up time of 6 months. Kaplan–Meier analysis showed that the difference of the cumulative survival rate of pterygium surgery methods was statistically significant (P < 0.001). Using the multivariate Cox regression model, 2 factors were found to be not correlated with the survival rate of patients with CGs: sex (P = 0.17) and the category of pterygium (primary or recurrent) (P = 0.96).CGs are an uncommon potential complication of pterygium surgery. The histologic characteristics, including the proliferation of inflammatory granulation tissue with large amounts of inflammatory cell infiltration, could be helpful to diagnose this disease. Surgical excision combined with corticosteroid drops proved to be a simple and effective treatment of CGs.