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Introduction  Eye pain is common and initially managed by primary care physicians. In the rare refractory case or atypical appearance, consultation with ophthalmology is needed. Case presentationA 35-year-old Hispanic male patient with a history of pterygium presented with complaints of worsening left eye pain for months .Over the past two weeks, the patient had also noticed more redness and soreness that occurred all day.  He noticed darkening in the medial vision of his left eye, persistence of left eye pain and visual changes. An excisional biopsy of the lesion was performed.  The final biopsy reports revealed an ocular surface squamous cell carcinoma in situ arising from pterygium.DiscussionTopical application and injections of immunotherapy such as mitomycin C and 5-fluorouracil have been shown to be effective.  Recurrence is high and follow-up examination by ophthalmology is essential.