Contjunctival Nevus Removal(eye birthmarks)

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Last updated 9/29/2019
Eye freckle, Assil Eye Institute

What's the freckle in the white part of my eye?

Freckles, birthmarks or moles can appear anywhere on the body, including on your eye. They’re known as nevi (one freckle is a nevus). A nevus that occurs on the clear film covering the white part of your eye (known as the bulbar conjunctiva) is called a conjunctival nevus.

 

Though it can occur in many parts of the eye, when present on the conjunctiva, this freckle very noticeably stands out against the white background. These Nevi are often located adjacent to the colored part of your eye (known as the iris). Their color can range from yellow to dark brown and it can lighten or darken over time.

 

Nevi are made up of pigment cells, called melanocytes, that provide color to your skin, hair and eyes. When several of these cells cluster together, they form a nevus.

 

In addition to occurring on the white covering of your eye, Nevi can also form inside your eye, such as on the iris (these look like tiny dark flecks in the colored part of your eye). You can also have a nevus under the retina lining the back of your eye (this is known as a choroidal nevus and is present in one out of ten people).

Are eye freckles dangerous?

 

A nevus is rarely cancerous, and people are often born with harmless eye nevi. A nevus that develops later in life is typically also harmless but, like a skin mole, it could possibly develop into cancer of the eye (called ocular melanoma) and so should be monitored with periodic eye exams.

 

Even though the odds are less than one percent that a freckle in the eye will turn into a an eye melanoma, it is possible that a conjunctival nevus can change into a melanoma as you age, so you should have regularly scheduled follow-up exams with your ophthalmologist.

 

Your eye doctor can take a picture of the nevus and compare pictures over time to see if there are any changes in its size or shape. Your doctor may ask you to have the nevus re-checked in six months. If the nevus does not change over a year or two, it is not likely to be malignant melanoma. If there has been no change over two years, then the nevus may either be left alone, or removed due to personal preference for cosmetic reasons (see below).


Are some people at greater risk of having an eye freckle?

Yes, they’re most commonly found in Caucasians (in fact, five percent have them) because light eyes, fair skin and burning easily when exposed to sun are also risk factors. Large scale studies have found a link between chronic sun exposure and the incidence of conjunctival nevi. A family history of nevi does not play a role in determining your likelihood of developing conjunctival pigmentation.

 

Are all eye spots the same?

Actually, no. There are two types of conjunctival pigmented lesions prevalent among darker skinned individuals that are also characterized by altered coloration in the eye:

 

  • Ocular Melanocytosis occurs in one out of every 2500 persons of black, Hispanic or Asian heritage. It is a conjunctival lesion involving only one eye that is usually accompanied by a slate grey colored patch in the skin near the affected eye.
  • Benign Melanosis, also called racial melanosis, typically involves both eyes and looks like patchy areas of increased pigmentation in the white part of the eye. It is common among middle aged people with dark complexions, affecting nearly 93% of blacks, 36% of Asians and 28% of Hispanics.

 

Conjunctival nevus causes

While the precise cause of nevi is not well understood, studies have found that prolonged sun exposure increases your chance of developing eye freckles. Indeed, nevi are more often found in older persons with a history of sunburns. Even though nevi are most common among Caucasians, all races can have eye freckles.

 

Symptoms of conjunctival nevus

Just as with freckles anywhere on your body, conjunctival nevi aren´t associated with any pain or discomfort whatsoever. Because nevi are asymptomatic, most people just notice new nevi when looking in the mirror.

 

Treatment for conjunctival nevus

Because nevi are painless and don´t affect your vision, they don’t necessarily require any treatment other than periodic observation to monitor for changes in your nevus over time. Although nevi tend to remain stable, it is possible for them to grow due to inflammation or hormonal changes. Your eye doctor will do a detailed examination of the front and inside structures of your eye such as the retina, the macula and optic nerve. This involves using special magnifying equipment to view the front of your eye, known as a slit lamp. A slit lamp examination is part of the regular eye care protocol performed at AEI.

 

Just as with skin cancer, during your eye examination, your doctor will look for the ABCDE clinical features of moles that warrant close monitoring:

 

  • Asymmetrical shape
  • Borders that are irregular
  • Color changes or several colors present
  • Diameter that has advanced
  • Evolution of the nevi´s appearance over time

 

Your eye doctor will take a picture of the nevus and will compare pictures over time to see if there are any changes in its size or shape. You may be asked to return to have the nevus re-checked in six months.

 

If the nevus does not change over a year or two, it is not likely to be melanoma. Because a nevus can change to a melanoma as you age, you should have it checked regularly and follow the exam schedule your ophthalmologist recommends.

 

Eye freckle removal surgery

Can I get my eye freckle removed? Yes, you can. At AEI, we remove Conjunctival Nevi for 2 common reasons: a suspicious appearance, or if they appear cosmetically undesirable to the patient.

 

If melanoma is suspected, your eye doctor will recommend an excisional biopsy, in other words removing the pigmented lesion surgically. The resulting hole in the conjunctiva is closed with dissolvable sutures, surgical “glue”, or laser cautery, depending on its size and location. The removed tissue would then be sent to a pathology lab to assess for the presence of cancer cells.

 

The removal of a cosmetic nevus is a much simpler and gentler procedure that involves using a very mild thermal brushing technique to extract the pigment from the surface of the conjunctiva. Recovery is typically quick and painless, with no trace of the prior nevus and, in our experience, resulting in great patient satisfaction. Because this treatment is considered cosmetic, it is not typically covered by insurance.

 

When to see your eye doctor about an eye freckle (nevus)

If you notice something that looks like a freckle in your eye that wasn’t there before, you should get it checked by an ophthalmologist. Although it’s very likely to be harmless, your ophthalmologist will want to examine it closely and to continue checking it over time to make sure that it doesn’t change.

 

Other reasons to see your eye doctor for a freckle include:

 

  • If you notice that your eye freckle has grown or changed in shape or color
  • If you are unhappy with the appearance of the conjunctival freckle and wish to know more about having it removed.

 

 

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