Conjunctival lesions are abnormal growths or changes that occur on the conjunctiva, the clear membrane covering the white part of the eye and the inner surfaces of the eyelids. These lesions are common and encompass a wide range of conditions, varying from harmless to those that may require medical attention. Understanding these changes can help individuals recognize when to seek professional eye care.
What Are Conjunctival Lesions?
The conjunctiva is a transparent, thin membrane that protects the eye, covering the sclera (the white outer layer of the eyeball) and lining the inside of the eyelids. Conjunctival lesions are abnormal tissue changes, growths, or discolored areas that develop on this membrane.
These lesions can arise from various factors, including prolonged exposure to sunlight and wind, chronic inflammation, or irritation. A genetic predisposition may also contribute to their development. Some lesions are present from birth, while others develop due to environmental influences or biological processes.
Common Types and Their Appearance
Several types of conjunctival lesions exist. Benign lesions are harmless. A pinguecula appears as a yellowish, slightly raised patch on the white of the eye, near the cornea, often on the side closer to the nose. This lesion is associated with sun and wind exposure.
A pterygium is another benign growth, presenting as a fleshy, wedge-shaped tissue that originates on the conjunctiva and can gradually extend onto the cornea. Like pinguecula, it is linked to sun exposure and develops on the nasal side of the eye. If a pterygium grows large enough to cover the pupil, it can interfere with vision.
A conjunctival nevus is a freckle or mole on the eye, appearing flat or slightly raised. While often brown, these lesions can also be colorless. Nevi are benign, though they can change in size or pigmentation. Conjunctival cysts are clear, fluid-filled sacs that are small and translucent.
In contrast, some conjunctival lesions can be serious. Conjunctival Intraepithelial Neoplasia (CIN), also known as dysplasia, is a precancerous lesion. It presents as a gelatinous, white, or reddish-brown patch, sometimes with visible feeder blood vessels.
Conjunctival melanoma is a rare but serious form of cancer that can develop from a pre-existing nevus or primary acquired melanosis (PAM). This malignant lesion appears as a dark, growing spot, but can also be unpigmented. Squamous Cell Carcinoma (SCC) is a slow-growing cancer that looks like a raised, gelatinous, or whitish lesion, often accompanied by prominent blood vessels.
Symptoms and When to Seek Care
Conjunctival lesions may or may not cause symptoms. Common sensations include irritation, redness, or a foreign body sensation. Individuals may experience dryness or blurred vision, particularly if the lesion extends onto the cornea and obstructs the visual axis.
Signs that warrant evaluation by an eye care professional include rapid growth or a significant change in the size, shape, or color of an existing lesion. The appearance of a new pigmented lesion also requires thorough examination. Persistent discomfort, pain, tenderness, or bleeding from the lesion are concerning. Any changes in vision, such as blurriness or an obstructed view, or inflammation and redness around the lesion that does not resolve, indicate a need for medical consultation.
Diagnosis and Treatment Options
Diagnosing conjunctival lesions involves a comprehensive eye examination, using a slit-lamp microscope to visualize the eye’s surface. Imaging techniques, such as optical coherence tomography (OCT) or ultrasound biomicroscopy (UBM), are used to assess the lesion’s characteristics and depth. For suspicious lesions, a biopsy, which involves taking a small tissue sample for laboratory analysis, is often performed to determine if the lesion is benign or malignant.
Treatment approaches vary depending on the type and nature of the lesion. Many benign, asymptomatic lesions may only require observation, with regular follow-up appointments to monitor for any changes. For lesions causing irritation, medical management with lubricating eye drops or anti-inflammatory drops can alleviate symptoms.
Surgical excision, the physical removal of the lesion, is performed for growths that cause significant symptoms, interfere with vision, or are suspected to be precancerous or cancerous. For precancerous or cancerous lesions, additional therapies such as cryotherapy (freezing the affected tissue) or chemotherapy drops or injections are used to prevent recurrence. Regular follow-up care is advised, especially for lesions under observation or following any form of treatment, to ensure long-term eye health.