The study examined 200 patients in rural southern China who underwent pterygium surgery with conjunctival tissue transplantation between 2016 and 2022. The average time to disease recurrence was 42 months, with half of the patients remaining recurrence-free for 72 months. Patients with recurrence were significantly older (mean 67.6 years vs. 60.3 years), had less education, longer exposure to sunlight (4.8 hours per day), and worse visual acuity before surgery. Multivariate analysis confirmed that advanced age at diagnosis is the only independent risk factor for recurrence. The incidence of recurrence in this rural population was characterized by a later onset compared to urban areas. The authors recommend extended follow-up and targeted health education, especially for elderly patients, to reduce the risk of disease recurrence.