Eye freckles, also known as ocular nevi, are common pigmented spots found on or inside the eye. Like skin freckles or moles, these spots form from clusters of melanin-producing cells. Eye freckles are harmless and generally do not disappear once formed.
Types of Eye Freckles
Eye freckles can appear in different parts of the eye. Iris freckles, or iris nevi, are pigmented spots on the iris, the colored part of the eye. These are often visible and common, especially in individuals with lighter eye colors.
Conjunctival freckles (conjunctival nevi) appear on the conjunctiva, the clear membrane covering the white part of the eye and the inside of the eyelids. These spots can range from yellow to brown and may sometimes appear slightly raised. They are among the most commonly observed eye freckles.
Choroidal freckles, or choroidal nevi, are located deeper within the eye, in the choroid layer beneath the retina. Unlike other types, choroidal nevi are not visible externally and can only be detected during a comprehensive dilated eye examination. Approximately 1 in 10 people have this type of eye freckle.
Permanence and Changes
Eye freckles are permanent pigmentations that do not go away once they appear. Like skin freckles, they are stable formations of pigment cells. While permanent, eye freckles can sometimes undergo subtle changes over time.
These changes might include a slight increase in size or an alteration in color intensity. Sun exposure and aging can influence these minor shifts. Most changes are benign but still warrant observation by an eye care professional. The transformation of an eye freckle into melanoma, a type of cancer, is rare, occurring in about 1 in 8,000 people with a uveal nevus.
Signs Requiring Medical Attention
While most eye freckles are benign, certain changes indicate a need for medical evaluation. An ophthalmologist should assess any eye freckle that exhibits asymmetry, meaning one half does not match the other. Irregular or blurred borders are also a sign to watch for.
Changes warranting professional attention include:
- Changes in color, such as uneven pigmentation, darkening, or multiple shades within the freckle.
- A rapid increase in the freckle’s diameter or overall dimension.
- Any elevation of a previously flat freckle, causing it to become raised or lumpy.
- Associated symptoms like new vision changes (blurriness, floaters, flashes of light), or any pain or discomfort around the freckle.
Managing Eye Freckles
For benign eye freckles, the most common approach is regular observation by an ophthalmologist. This involves periodic dilated eye exams, typically every six to twelve months, to monitor the freckle for changes. During these examinations, eye care professionals often take baseline photographs of the nevus. These images provide an important reference point, allowing doctors to compare the freckle’s appearance over time and detect subtle alterations in size, shape, or color.
Treatment for an eye freckle is considered only in rare instances, primarily if it shows signs of transforming into melanoma or if it causes significant vision problems or discomfort. Such treatments, which might include radiation therapy, laser therapy, or surgery, are reserved for cases where the nevus is cancerous or poses a direct threat to eye health. Regular comprehensive eye exams are important for maintaining overall eye health and for the early detection of any potential issues, regardless of whether an eye freckle is present.