adjunctive therapies performed to reduce the recurrence rate have severe complications. The aim of this study was to compare the safety and efficacy of conjunctival Z-plasty and conjunctival autograft application in primary pterygium surgery. Methods: Forty two consecutive patients had undergone pterygium excision with either conjunctival autografting or conjunctival Z-plasty randomly. Operation time was recorded for each eye. Mean follow-up time in the autograft group and the Z-plasty group was 18 and 17 months, respectively. Results: Loose graft was observed in 1 (4.7%) patient, tenon’s granuloma in 1 (4.7%) patient, and recurrence in 1 patient (4.7%) in the autograft group. Recurrence was observed in 1 patient (4.7%), and suture releasing in 1 patient (4.7%) in the Z-plasty group. Mean operation time was 36.14 ± 3.8 (range, 30-45) minutes and 16.10 ± 2.0 (range, 13-20) minutes in the autograft group and the Z-plasty group, respectively (p<0.001). Conclusion: Conjunctival Z-plasty is a safe and an effective procedure to reduce the recurrence rate following primary pterygium excision. This method has some advantages over conjunctival autografting technique, such as shorter operation time and easy application.