You’re probably familiar with freckles on your skin, but did you know you can also get freckles in your eye? An eye freckle is called a nevus (“nevi” is the plural), and different kinds of freckles can occur on different parts of the eye.
While usually harmless, they do need to be monitored by a doctor because there’s a small chance they can become a type of cancer called melanoma.
There are several kinds of eye freckles. It’s important to have freckles examined by an eye doctor to ensure proper diagnosis and treatment planning.
While you can be born with an eye freckle, you can also develop one later in life. As with freckles on the skin, these are caused by melanocytes (cells containing pigment) that are clumped together.
A conjunctival nevus is a pigmented lesion on the white part of the eye, known as the conjunctiva. These nevi make up more than half of all conjunctival lesions and usually appear in childhood.
When the eye freckle is on the iris (the colored part of the eye), it’s called an iris nevus. Approximately 6 in 10 people have one.
Research has associated increased sun exposure to formation of new iris nevi, but more studies need to be done. They’re always flat and don’t pose any risk. These are different from raised masses on the iris or iris melanoma.
When a doctor tells you that you have an eye lesion that needs to be followed, they’re likely referring to a choroidal nevus. This is a flat pigmented lesion that’s benign (noncancerous) and located in the back of the eye.
According to the Ocular Melanoma Foundation, roughly 1 in 10 people have this condition, which is basically an accumulation of pigmented cells. While choroidal nevi are generally noncancerous, there is a small potential that they can become cancerous, which is why they need to be followed by a doctor.
Conjunctival nevi often appear as a visible freckle on the white part, with no other symptoms. They tend to remain stable, but they can change color over time, especially during puberty or pregnancy.
The darkening color can be mistaken for growth, which is why it’s important for this type of nevi to be closely monitored.
Iris nevi can usually be spotted through eye exams, especially if you have a darker iris. They occur more commonly in people with blue eyes and are more easily seen in these individuals.
Choroidal nevi are typically asymptomatic, although they may leak fluid or be accompanied by abnormal blood vessel growth.
Sometimes this causes a detached retina or vision loss, which is why it’s so important to monitor these kinds of nevi. Because they don’t cause symptoms, they’re usually detected during a routine fundoscopic exam.
While most eye freckles remain noncancerous, it’s important to have an eye doctor monitor them. There is a small chance that they can develop into eye melanoma. The earlier you notice that a nevus starts to change, the sooner it can be treated — before it possibly turns into something more serious.
Close observation is key to detecting any possible cancerous changes and catching possible metastasis early. Your eye doctor should examine the nevus every 6 to 12 months, noting the size, the shape, and whether there is any elevation.
Rarely, some lesions can herald other conditions. Having pigmented lesions on fundoscopic exams in both eyes can indicate a condition called congenital hypertrophy of the retinal pigment epithelium (CHRPE), which is completely asymptomatic. If CHRPE is in both eyes, this could be a symptom of a hereditary condition called familial adenomatous polyposis (FAP).
FAP is very rare. It causes 1 percent of new colorectal cancers annually. Although rare, individuals with FAP have a 100 percent chance of developing colorectal cancer by the age of 40 if their colon isn’t removed.
If an eye doctor diagnoses CHRPE, talk with your doctor about the risks and benefits of genetic testing.
They might recommend that you see a specialist to discuss your options.
Most eye freckles are benign, but if you have one, it needs to be monitored by an eye doctor with frequent exams, usually every six months to a year, to document the size, shape, and any color changes of the freckle.
While there are associations between nevi (particularly choroidal and iris) and UV light, more research needs to be done to clarify the role of the latter. However, wearing sunglasses outside might help reduce the risk of complications with nevi.
If a nevus does need to be removed due to any complications, melanoma, or suspicion of melanoma, this is done with surgery. Depending on the individual situation, local excision (using a very small blade) or argon laser photoablation (using a laser to remove tissue) are possible options.
If you have an eye freckle, this is generally nothing to worry about. Many times, these are seen on an eye exam, which is why it’s so important to get regular checkups.
Once the freckle has been diagnosed, talk with your doctor about a checkup schedule since it needs to be carefully monitored to avoid any potential complications.
If you have eye freckles in both eyes, ask your doctor about CHRPE and FAP to see what they recommend as a next step.