Brown spots on the white part of the eye, known as the sclera, are common and usually harmless, similar to freckles or moles on the skin. While often benign, understanding their nature and when professional attention is needed is important for eye health.
Identifying Common Brown Spots
The most common type of brown spot on the white part of the eye is a conjunctival nevus, often called an “eye freckle.” This pigmented growth appears on the conjunctiva, the clear tissue covering the white part of your eye. Conjunctival nevi vary in color from yellow to dark brown, and can be flat or slightly raised. About half also contain small, clear cysts, which can be a distinguishing characteristic.
These spots form from a collection of melanocytes, specialized cells that produce melanin, the pigment responsible for skin, hair, and eye color. While most nevi are harmless, other types of pigmentation include racial melanosis, which are flat, benign areas common in people with darker skin tones, and primary acquired melanosis (PAM), typically found in Caucasians. PAM, though usually flat, can sometimes change and may require monitoring.
What Causes These Spots?
Conjunctival nevi result from an accumulation of melanocyte cells on the conjunctiva. Some individuals are born with these eye freckles, indicating a genetic predisposition.
Beyond genetics, external factors also play a role in the development and appearance of these spots. UV light exposure can increase the chances of developing a nevus or cause existing ones to darken. Similar to skin freckles, which can become more prominent with sun exposure, eye freckles may also be influenced by UV radiation. Hormonal changes, such as during puberty or pregnancy, can also change a conjunctival nevus’s color and size.
When to Consult an Eye Doctor
While most brown spots on the eye are harmless, certain changes or symptoms warrant professional evaluation. Consult an eye doctor if you notice any changes in the size, shape, color, or elevation of an existing spot. New brown spots appearing, especially in adulthood, should also be checked.
Other concerning symptoms include pain, irritation, or any changes in vision, such as blurry vision, flashing lights, or floaters. Redness, discharge, or inflammation associated with the spot are also reasons to seek medical advice. These signs could indicate a need for closer monitoring or, in rare cases, suggest a more serious condition like conjunctival melanoma.
What to Expect After Diagnosis
For benign conjunctival nevi, which are typically asymptomatic and do not affect vision, no active treatment is usually necessary. Instead, routine monitoring is recommended to track any changes over time. This often involves annual eye exams where the ophthalmologist may take photographs or use imaging techniques like optical coherence tomography (OCT) to document the nevus’s size, shape, and characteristics.
If the spot shows suspicious features or undergoes concerning changes, further diagnostic steps may be taken. This could include more frequent monitoring or, in some cases, a biopsy to determine if the lesion is cancerous. Should a conjunctival nevus be diagnosed as a melanoma, treatment options may include surgical removal, radiation therapy, or, in very rare advanced cases, removal of the eye. Following medical advice and adhering to the recommended follow-up schedule is important for managing any eye condition.