Complications are presented according to time of occurrence. Preoperative complications include uncontrolled and excessive inflammation, uncooperative patient in poor health and a previously recurrent pterygium. Intraoperative complications include poorly administered anesthesia, excessive and persistent hemorrhage, excessive dissection and surgical trauma leading to exaggerated postoperative inflammation. Postoperative complications include recurrence based on inflammation, persistent hematoma, hyperemia, pain, corneal excavation, graft slippage, flap dehiscence, bare sclera, scleral necrosis, granuloma, and symblepharon. Specific cases are presented and their management discussed in detail. Management of induced astigmatism is detailed. The pathogenesis of recurrence, its prevention and recommended techniques of management are provided along with pertinent case histories and outcomes.