Pterygium, as a common global ocular surface disease, affects patients′ vision and appearance, and can lead to blindness in severe cases. The common surgical methods currently include simple pterygium excision, pterygium transposition, corneal limbal stem cell combined with autologous conjunctival transplantation, and amniotic membrane transplantation. Although its surgical therapy has undergone evolution, postoperative recurrence and complications remain the core challenges that plague patients and clinical physicians. The choice of surgical timing, procedure, and postoperative complication management is related to the patient's postoperative ocular surface stability and recurrence rate. Evidence based medicine should be followed to comprehensively consider the progression of pterygium and its impact on the patient's visual function and quality of life. The reconstructive surgical technique represented by corneal limbal stem cell combined with conjunctival transplantation can effectively reduce the postoperative recurrence rate and is the cornerstone of current pterygium surgical therapy. The management of postoperative recurrence and surgical related complications such as dry eye is the key to ensuring long-term efficacy. In the future, personalized therapies combining new biological therapies and tissue engineering achievements will be the development direction for precise and minimally invasive treatment of pterygium.