An “Eye Freckle” on Your Exam Report: What a Nevus Is, and Why Your Doctor Wants to Watch It

Oak Park families spend a lot of time outdoors, from the Medea Creek trail to weekend soccer at the neighborhood parks. Sun exposure is part of that lifestyle, and so, for some people, is a finding that surprises them at a routine eye exam: a nevus, or “eye freckle.”

What a nevus is

The American Academy of Ophthalmology (AAO) describes a nevus as a common colored growth on or in the eye, similar to a mole on the skin. It is made of melanocytes, the pigment cells that color our hair, skin and eyes, which have clumped together. People can be born with them, and a spot that develops later in life is usually harmless too, but may carry a greater risk of becoming cancer.

Where they appear

• Conjunctival nevus. A freckle-like spot on the clear film over the white of the eye. Very common, yellow to brown, and usually not cancerous.
• Iris freckles. Tiny dark brown flecks on the colored part of the eye. Harmless and usually do not become melanoma.
• Iris nevi. Larger dark spots that extend deeper into the iris. Usually benign, but monitored.
• Choroidal nevus. A spot under the retina, inside the eye, that can only be seen during an eye exam. It may be gray, yellow, brown or multicolored.

Why it is watched

The AAO explains that an eye nevus needs to be watched regularly by an ophthalmologist because, like a skin mole, it could develop into eye cancer. For a choroidal nevus, the doctor checks whether it is raised, orange-colored or leaking fluid. Any of those findings means it could be, or could become, a small choroidal melanoma. Imaging such as OCT may be used to examine it more closely.

Sun protection matters

The AAO notes there may be an association between UV exposure and developing nevi, and recommends sunglasses that block UV light. On bright trail days, a hat and UV-blocking sunglasses are an easy habit.

What to expect

Most nevi simply get photographed and compared at future visits. If a spot changes or looks suspicious, we refer patients to an ocular oncology or retina specialist for further evaluation.

For eye health articles written for readers across the country, see this national eye health blog.

An eye freckle is usually nothing more than that. The key is knowing it is there and keeping your follow-up visits.

Source: Nevus (Eye Freckle) (American Academy of Ophthalmology). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.