Objective To explore the effect of pterygium excision+autologous limbal stem cell transplantation at different corneal invasion lengths of pterygium and its influence on aesthetic satisfaction. Methods A total of 96 patients with pterygium admitted to our hospital from April 2022 to March 2026 were selected. According to the corneal invasion length of pterygium, they were divided into group A, group B and group C, with 32 patients in each group. The corneal invasion length of pterygium was <2 mm in group A, 2-3 mm in group B, and >3 mm in group C. All patients underwent pterygium excision+autologous limbal stem cell transplantation. The clinical indicators, recurrence rate and aesthetic satisfaction were compared among the three groups. Results The operation time, intraoperative corneal wound area and postoperative corneal epithelial healing time in group A were better than those in group B and group C (P <0.05). Group B showed better results than group C in the above indicators (P <0.05). The recurrence rate of group B was 3.13%, lower than 25.00% in group A and 28.13% in group C (P<0.05). There was no significant difference in recurrence rate between group A and group C (P >0.05). The aesthetic satisfaction score of group B was higher than that of group A, and that of group A was higher than that of group C (P <0.05). Conclusion For patients with pterygium, surgery performed when the pterygium invades the cornea by 2-3 mm achieves the lowest recurrence risk. This timing helps to reduce corneal damage caused by delayed surgery and improves postoperative ocular cosmetic outcomes while ensuring therapeutic efficacy