Background: Pterygium is a triangular fibrovascular subepithelial in growth of degenerative bulbar conjunctival tissue over the limbus on to the cornea. Pterygium typically develops in patients who have been living in hot climates and may represent a response to chronic dryness and ultraviolet exposure. Methods: This prospective study included 70 patients with primary pterygium, randomly divided into two groups: Group A treated with conjunctival autograft and Group B with intraoperative mitomycin C. Standard preoperative evaluation, surgery under local anesthesia, and postoperative follow-up up to 6 months were performed to assess visual outcomes, complications, and recurrence. Results: A total of 70 patients with primary pterygium were divided into two groups: Group A (conjunctival autograft) and Group B (mitomycin C). Most patients in Group A were aged 31–40 years (40%), while Group B had more in the 51–60 range (28.6%) (p=0.018). Males predominated in both groups. Visual acuity improved in both, with 6/6 vision in 37.1% of Group A and 28.6% of Group B at 6 months. Complications were fewer in Group A (11.5%) than in Group B (54.3%), making conjunctival autograft the safer and more effective method. Conclusion: The study of 70 eyes with primary pterygium showed that conjunctival autograft had fewer complications and a lower recurrence rate (2.9%) compared to intraoperative mitomycin C (14.3%), proving it to be a safer and more effective method for managing primary pterygium.