Abstract To study the role of Body Mass Index (BMI) and serum lipid profile molecules, as well as their derivative indexes in primary pterygium patients. The patient group consisted of 110 patients with primary pterygium diagnosed in our center between January 2019 and December 2020, while the control group consisted of 144 healthy persons of similar age and sex diagnosed during the same time period. The BMI, serum lipid profile molecules and their derivative indexes of both groups were analyzed retrospectively. In the patient group, 62 patients were overweight or obesity and 104 patients with dyslipidemia. Among them, body mass index (BMI), serum triglycerides (TG), total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C) and apolipoprotein B (Apo‐B) levels were significantly higher than those in the control group (p 0.05). Logistic analysis indicated that obesity, TC and HDL‐C/LDL‐C ratio are independent risk factors influencing the onset of pterygium (p