The treatment of ocular pterygium has been subjected to the development and application of various new strategies in the last few years. The worrisome problem of recurrence seems to have been significantly reduced with the newer methods of treatment. The field is however, still evolving. This review sets out to examine the various newer approaches to treating pterygium and in spite of the recent developments, to highlight the remaining challenges thereby suggesting the possible direction of future research. Also, to suggest treatment options for Ophthalmologists working in environments with limited resources. A library search and Internet search of PubMed and Google was conducted in 2010. Search terms included "pterygium in combination with surgery", "radiotherapy", "chemotherapy", "graft", and "recurrence." Abstracts were reviewed and relevant articles especially those published from the year 2000 to date were given more attention and when possible, reviewed in full. The relevant references in such articles were also reviewed. In conclusion, excision and adjunctive treatment with mitomycin C or conjunctival autograft is the most acceptable and most popular mode of treating both primary and recurrent pterygium. Outcomes seem to have been further improved with adjuvant combination therapy and the introduction of newer approaches to treatment.