Introduction: Pterygium is a degenerative disease of the conjunctiva, characterized by cellular proliferation, tissue remodeling and inflammation. The conventional conjunctival autograft done for pterygium removal is considered to be efficient with less recurrence rate. A modification of it, the extended conjunctival autograft following extended pterygium removal, which removes all the pterygium tissue from the eye with improved cosmesis and least recurrence rate. On using 0.05% topical cyclosporine postoperatively, decreases the recurrence rate to the least. Our aim is to study the efficacy of conjunctival autograft after extended pterygium excision in primary fleshy pterygium and to determine the recurrence rate after surgery with and without cyclosporine. Methodology: This study was conductedas a Prospective, observational, case-control study in patients with primary fleshy pterygium, who satisfy the inclusion criteria after obtaining consent.60 patients were selected and divided into two groups. 30 patients were included in Group I in whom surgery (extended pterygium removal followed by extended conjunctival autograft) with post-operative 0.05%topical cyclosporine was given 6 hourly for 6 months and 30 patients in Group II had surgery done with postoperative placebo drops (lubricants). Results and discussion: There was no statistically significant differences based on age, sex, preoperative visual acuity, astigmatism between the two groups. On analysis of results Group II patients on placebo, had 20% recurrence compared to group I patients on cyclosporine with 0% recurrence rate which was statistically significant with p value of 0.024. There was an improvement in baseline visual acuity and a decrease in astigmatism postoperatively in both the groups. The postoperative complications and side effects were almost equal in both groups, which was not statistically significant suggesting that 0.05%topical cyclosporine is a safe and effective drug for postoperative use. Conclusion: The study to compare the efficacy of extended conjunctival autograft followed by extended pterygium removal with post-operative 0.05%topical cyclosporine shows significant results in visual acuity improvement, with least complications and low recurrence. Hence, it is an effective method for pterygium removal with least complications and recurrence.