Noticing a spot on the white part of your eye (the sclera) can be an alarming discovery, but these visible changes are extremely common. Spots appear on the clear membrane covering the sclera, called the conjunctiva, and are often harmless and benign. Understanding the nature and origin of these visual signs helps determine if they are simply a cosmetic variation or require professional evaluation. This overview focuses on the most frequently encountered spots visible on the outer surface of the eye.
Pigmented Spots: Freckles, Moles, and Nevi
Darker spots on the eye are typically caused by an accumulation of melanin, the pigment responsible for coloring our hair, skin, and eyes. These collections of pigment are known as nevi, the medical term for a mole or freckle. A conjunctival nevus appears as a flat or slightly raised spot on the white of the eye, often ranging in color from yellow to brown.
These nevi are usually present from birth or develop in childhood and are almost always benign, though their color may darken due to hormonal changes or sun exposure. Separately, iris freckles are tiny, dark specks found on the colored part of the eye (the iris). Unlike freckles, iris nevi are larger, darker spots that grow deeper into the iris tissue.
All pigmented spots require periodic monitoring, similar to skin moles, due to a small risk of malignant transformation into ocular melanoma. An eye care professional typically photographs the spot during routine exams to track changes in size, shape, or color over time. A stable, benign nevus does not usually affect vision or require treatment beyond regular observation.
Red Spots: Subconjunctival Hemorrhage
A bright red spot that appears suddenly on the white of the eye is most often a subconjunctival hemorrhage, essentially an eye bruise. This occurs when one of the tiny, fragile blood vessels beneath the clear conjunctiva ruptures. The released blood becomes trapped between the conjunctiva and the sclera, creating a red patch.
The rupture is typically caused by a sudden, temporary increase in venous blood pressure, such as from a forceful sneeze, a hard cough, vomiting, or straining. Minor eye trauma or vigorous rubbing can also lead to this bleeding. Despite the intense appearance, a subconjunctival hemorrhage is usually painless, does not affect vision, and is a harmless condition.
The blood is naturally absorbed by the body over time, and the spot resolves on its own without treatment, much like a skin bruise fading. Resolution typically takes one to two weeks, during which the bright red color may darken and fade to a yellowish hue before disappearing. Lubricating eye drops may be used if the eye feels slightly scratchy or irritated.
Yellow and Raised Spots
Yellowish or white, slightly raised spots on the sclera near the cornea are commonly one of two distinct conditions: a pinguecula or a pterygium. Both are non-cancerous growths strongly associated with chronic exposure to environmental irritants, especially ultraviolet (UV) light, wind, and dust. They typically appear on the side of the eye closest to the nose.
A pinguecula is a small, yellowish-white bump consisting of a deposit of protein, fat, or calcium. This growth remains confined to the conjunctiva and does not extend onto the clear corneal surface. It generally does not affect vision, but may cause mild irritation, dryness, or a gritty sensation, which can be managed with artificial tears.
A pterygium is a fleshy, wedge-shaped growth that may begin as a pinguecula but spreads onto the cornea. This growth contains blood vessels and can be pink or reddish, earning it the common name “surfer’s eye.” If the pterygium grows toward the center of the eye, it can change the shape of the cornea, causing astigmatism and potentially blurring vision.
Treatment often begins with lubricating eye drops to relieve irritation and inflammation, particularly if the growths become swollen (pingueculitis). Surgical removal is reserved for a pterygium that significantly interferes with vision or causes persistent discomfort that topical treatments cannot alleviate. Protecting the eyes with UV-blocking sunglasses is the best way to slow the progression.
When a Spot Signals Trouble
While most eye spots are benign, certain changes require immediate consultation with an eye care professional. Any pigmented spot, such as a nevus, that rapidly increases in size, changes color, or alters its shape requires urgent evaluation. This rapid change can, in rare instances, signal the development of ocular melanoma.
Symptoms indicating a more serious issue include acute changes in vision, such as sudden blurriness, loss of peripheral sight, or the appearance of flashes of light and an increase in floaters. Severe eye pain, light sensitivity, or a spot accompanied by discharge or fever are also red flags. A change in the size or shape of the pupil warrants a prompt examination.
Even if a spot seems stable, routine comprehensive eye examinations are necessary because a physician can view parts of the eye that are not visible in a mirror. This allows for the detection of more serious, non-surface spots, such as choroidal nevi, which are located at the back of the eye. Regular monitoring ensures that any subtle changes are caught early, allowing for timely intervention.