<p>This study aims to evaluate the efficacy of combining bandage contact lens with nasal margin suture fixation in pterygium resection, as well as to observe its effects on the levels of inflammatory cytokines measured in tear samples. This randomized controlled research involved the selection of 80 patients (80 eyes) who underwent limbal conjunctival autograft (LCAG) procedures at Chengfei Hospital between June 2022 and June 2024. Subjects were allocated in a 1:1 ratio to two groups: group 1 utilized bandage contact lens combined with nasal margin suture fixation, while group 2 employed bandage contact lens combined with traditional interrupted suture. Ultimately, 37 patients (37 eyes) in each group successfully completed all scheduled follow-up assessments. The evaluation indicators include operative time, Visual Analog Scale (VAS) scores, thickness of limbal–conjunctival autograft, levels of inflammatory cytokines in tears such as interleukin-6 (IL-6) , tumor necrosis factor α (TNF-α) , and transforming growth factor beta1 (TGF-β1) , as well as postoperative complications. Group 1 exhibited a significantly greater reduction in operative time compared to Group 2 (<i>t</i> =  − 3.921, <i>P</i> &lt; 0.001). On the 2nd day, 3rd day and 1st week postoperatively, the VAS scores for group 2 were consistently higher than those for group 1 (<i>t</i> = 5.41, 5.07, 4.44; all <i>P</i> &lt; 0.001). On the 2nd day postoperatively, the thickness of limbal–conjunctival autograft in group 1 was found to be greater compared to group 2 (<i>t</i> = 9.78, <i>P</i> &lt; 0.001). However, this trend reversed by the 1st week postoperatively (<i>t</i> =  − 5.84,<i> P</i> &lt; 0.001). By the 1st month postoperatively, there was no statistical divergence (<i>t</i> = 0.74, <i>P</i> = 0.461). Furthermore, on the 1st week and 1st month postoperatively, the levels of IL-6 and TNF-α in group 2 were significantly higher than those in group 1 (all <i>P</i> &lt; 0.05). However, no significant differences were observed in the average levels of TGF-β1 between the two groups throughout the observation period (<i>F</i> = 1.56, <i>P</i> = 0.216). There were no statistically significant differences between the two groups regarding sub-conjunctival hemorrhage, graft retraction, and graft edema (<i>χ</i>² = 0.237, 0.063, 0.084; <i>P</i> = 0.626, 0.802, 0.772). In group 2, only one patient with T3 (2.70%) experienced recurrence. The combination of bandage contact lens and nasal margin suture fixation is a safe and effective method for treating pterygium. Its efficacy is associated with the reduction of postoperative ocular surface inflammatory response, characterized by decreased levels of IL-6 and TNF-α in tears, as well as early improvement in patients’ subjective symptoms, indicated by a reduction in VAS scores.</p><p><b>Trial Registration</b>: Chinese Clinical Trial Registry (ChiCTR2600117302; registered 22 January2026, retrospectively).</p>