Background: Pterygium is a common ocular surface disorder that can lead to discomfort, inflammation and visual disturbances. Surgical excision remains the mainstay of treatment and conjunctival autograft and intraoperative mitomycin-C (MMC) are widely used techniques. This study compared postoperative symptom resolution following these two methods. Methods: This prospective study was conducted in the Department of Ophthalmology, Mymensingh Medical College Hospital and BNSB Eye Hospital, Mymensingh, Bangladesh, from January 2008 to June 2009. Patients undergoing primary pterygium excision were allocated into two groups: Group A (conjunctival autograft) and Group B (MMC). Postoperative symptoms of redness, foreign body sensation, photophobia, lacrimation, itching and mean tearing and foreign body sensation scores were assessed preoperatively. Results: Preoperatively, moderate redness was higher in Group A (74.3%), while mild redness predominated in Group B (51.4%). By the 3rd POM, 94.3% of Group A and 74.3% of Group B had no redness. Absence of foreign body sensation reached 91.4% in Group A and 77.1% in Group B at the 3rd POM. Photophobia resolved in 94.3% of Group A and 57.1% of Group B by the 6th POM. Lacrimation improved markedly, with 94.3% of Group A and 80.0% of Group B showing Grade-0 by the 6th POM. Tearing and foreign body sensation scores showed a similar trend, reaching zero at the 3rd POW in both groups but rising slightly thereafter, more prominently in Group B. Conclusion: Conjunctival autograft demonstrated more sustained postoperative symptom relief than intraoperative MMC in primary pterygium surgery.