Pterygium is a fibrovascular proliferative lesion of the bulbar conjunctiva that progressively invades the corneal surface, arising from a complex interplay of chronic ultraviolet radiation, oxidative stress, and limbal stem cell dysfunction, with pathophysiological mechanisms involving fibroblast activation, extracellular matrix remodeling, and angiogenesis that collectively account for the condition's well-documented tendency toward recurrence after surgical removal. The high postoperative recurrence rate associated with conventional bare-sclera excision, reported in some series to exceed 30 to 80 percent, has driven continued investigation into adjunctive strategies capable of modulating the wound-healing response at the surgical site. This prospective comparative clinical study was undertaken to evaluate the efficacy and safety of conjunctival flap transposition with simultaneous burial of the excised pterygium tissue performed either as a standalone procedure (Group 1, n=46) or in combination with intraoperative application of mitomycin C (Group 2, n=44) in patients presenting with primary nasal or temporal pterygium encroaching upon the cornea. A total of 90 eyes in 90 consecutive patients were enrolled from a single tertiary ophthalmology unit, randomized by allocation into the two groups, and followed for a minimum of six months with recurrence graded on a standardized four-grade scale. The primary findings demonstrated that Grade 0, or no recurrence, was observed in 69.6 percent of Group 1 patients and in 84.09 percent of Group 2 patients, indicating a clinically meaningful reduction in recurrence attributable to mitomycin C adjunction. Grade 3 true corneal recurrence occurred in 6.5 percent of Group 1 versus 2.27 percent of Group 2. While Group 2 demonstrated superior recurrence suppression, it was associated with a higher incidence of delayed wound healing (13.64%) and superficial punctate keratitis (13.64%), reflecting the known antiproliferative toxicity of mitomycin C on ocular surface epithelium. These findings support the cautious, judicious use of intraoperative mitomycin C as an adjunct to conjunctival flap transposition in appropriately selected patients, and underscore the need for further dose-optimization and long-term follow-up studies to refine its clinical application.