Objective To explore the effect of surgical timing selection for pterygium on refractive status and aesthetic effect. Methods A total of 80 patients (80 eyes) with pterygium admitted to Guangyang District Ophthalmology Hospital of Langfang City from August 2023 to January 2024 were selected, and they were divided into the control group and the observation group according to corneal invasion depth, with 40 patients (40 eyes) in each group. The control group underwent surgery when pterygium corneal invasion >3.5 mm, and the observation group underwent surgery when pterygium corneal invasion ≤3.5 mm. The symptom improvement, refractive status, tear film function, postoperative recovery, satisfaction with aesthetic effect, complication rate and recurrence rate were compared between the two groups. Results The scores of eye pain, foreign body sensation, photophobia and bulbar conjunctival hyperemia in the observation group at 1 week after operation were lower than those in the control group (P<0.05). The UCVA, SIT and BUT in the observation group at 1 week after operation were higher than those in the control group, and the CA was lower than that in the control group (P<0.05). The postoperative recovery rating of the observation group was better than that of the control group (P<0.05). The satisfaction with aesthetic effect in the observation group (97.50%) was higher than that in the control group (72.50%) (P<0.05). The incidence of complications in the observation group (5.00%) was lower than that in the control group (25.00%) (P<0.05). The recurrence rate of the observation group (2.50%) was lower than that of the control group (25.00%) (P<0.05). Conclusion Compared with delaying surgery until pterygium corneal invasion >3.5 mm, operating when invasion is ≤3.5 mm represents the optimal surgical timing. It can effectively improve the refractive status and tear film function, enhance the postoperative recovery and satisfaction with aesthetic effect of patients, and reduce the incidence of complications and recurrence rate.