Introduction: Pterygium is a fibrovascular growth of the palpebral conjunctiva extending over the corneal surface. It is more common in dry, dusty, windy environment. Sun exposure acts as an inciting factor for inflammation to occur and leading to pterygium development. However, bilateral double-headed hereditary pterygium presents a rare and intriguing manifestation.

Observation: Here we present a case of a 64 year old male with recurrent, bilateral double headed pterygium, shedding light on its hereditary predisposition and potential impact on the posterior segment. He was a field worker and a non-smoker with no history of trauma, systemic condition or any surgery except the pterygium excision in his left eye 6 years back. He also has increased retinal thickness with disc and macular oedema and inferior exudative retinal detachment. 

Conclusion: Pterygium may have a hereditary predisposition and the inflammatory and degenerative involvement of the anterior segment in pterygium may also affect the posterior segment thus emphasizing the multifactorial nature of pterygium development.