Everything You Need to Know About Eye Freckles

Freckles on the skin are common, but did you know that freckles can also occur on your eyes? A freckle in your eye may seem unusual; however, it is actually pretty common and typically harmless. Your eye doctor may still advise you to watch it over time, though. It’s rare, but eye freckles can turn into a type of cancer called melanoma.

Here’s a comprehensive guide about eye freckles.

What Are Eye Freckles?

An eye freckle, technically known as a “nevus” (or “nevi” for plural) is similar to the moles and freckles on your skin. Eye freckles can be brown, gray, yellow or a combination of colors. Nevi are typically made by special cells called melanocytes, which are responsible for giving color to your skin and eyes. These cells are usually spread out. But if enough of them clump together, they can form a nevus.

Nevi can be located on different parts of your eye. Sometimes they’re easy to spot, while other times they’re hidden. When they’re located at the back of the eye, they’re hidden and can only be seen by your eye doctor. Some types of nevi can form before birth, while others (like iris freckles) are likely to show up later in life. While most nevi are harmless, it’s important to undergo an eye examination on a regular basis so your eye doctor can monitor your nevi and check for underlying eye conditions.

Eye freckles have different names depending on their location: conjunctival nevus (found on the surface of the eye), iris nevus (found in the colored part of the eye) and choroidal nevus (found under the retina or in the back of the eye).

What Causes Eye Freckles?

Eye freckles have varying causes. These are the leading factors behind eye freckle development:

• Race: Choroidal nevi are more common in people with lighter skin tones than those with darker complexions.

• Sun Exposure: It is possible for sun damage to increase your risk of nevi. Some evidence suggests that people who spent more time in the sun have more iris freckles.

Here are some common conditions that can cause eye freckles:

• Conjunctival nevus: This is a pigmented lesion on the conjunctiva, or the white part of the eye. This type of nevi usually appears in childhood, and it accounts for more than half of all conjunctival lesions.

• Iris nevus: This type of eye freckle is found on the iris, or the colored part of the eye. It shows up in approximately 60% of people, and it is commonly associated with excessive sun exposure. Iris freckles are typically flat and do not pose any risk. They are different from iris melanoma, or raised masses on the iris.

• Choroidal nevus: This type of nevi is located in the back of the eye. It is a flat pigmented lesion that is benign, with roughly one in 10 people developing this type of nevus. Although it is generally noncancerous, a choroidal nevus still has a small potential to become cancerous. That is why it needs to be followed by your eye doctor.

Other Symptoms That May Accompany an Eye Freckle

In the case of conjunctival nevi, no other symptoms usually appear other than the visible freckle on the white part of the eye. They are mostly stable over time, but their color may change, particularly during pregnancy or puberty. A darkening color can be mistaken for growth, so you should still closely monitor this type of eye freckle.

Iris nevi can be detected through an eye exam. However, they can also be more easily seen in individuals with blue eyes.

Choroidal nevi are asymptomatic, so they are usually detected during a routine fundoscopic exam. In some cases, though, they may leak fluid or occur in conjunction with abnormal blood vessel growth. They may also cause a detached retina or vision loss, so it is important to monitor this type of nevi. Your doctor may recommend a checkup every three to six months for the first year or two upon identification. They will likely want to keep a close watch for possible changes. Your eye exam may involve dilating the eyes with special eye drops.

Treatment

Generally, eye freckles do not require treatment because they are usually harmless — much like the moles and freckles on your skin. They are not likely to affect your vision. The only time you may need treatment is if your doctor thinks your nevus might be a melanoma. In this case, your eye freckle would have to be monitored by an eye doctor through regular exams in order to document any size, shape or color changes.

In the event that complications occur and the nevus needs to be removed, this can be done through surgery. Typically, the options for surgery are local excision with a very small blade and argon laser photoablation (a laser is used to remove the tissue).

Possible Complications

Eye freckles are usually noncancerous. However, since there is still a small chance that they can develop into melanoma, it is crucial to have any nevi monitored by an eye doctor. The earlier you notice changes in the nevus, the sooner it can be treated, allowing you to avoid a more serious condition.

In rare cases, some lesions can indicate other conditions. For instance, pigmented lesions on fundoscopic exams in both eyes could indicate congenital hypertrophy of the retinal pigment epithelium (CHRPE), a condition that is completely asymptomatic. CHRPE in both eyes could be a symptom of a hereditary condition called familial adenomatous polyposis (FAP).

FAP is very rare and is linked to 1 percent of new colorectal cancers per year. Even though this rarely happens, individuals with FAP have a 100% chance of developing colorectal cancer by age 40 if their colon is not removed. To learn more about the risks of CHRPE, it is best to consult with your eye doctor and see if you need more tests to get a proper diagnosis. You may also ask them about the pros and cons of genetic testing. They can recommend a specialist to discuss your options in detail.

That said, there is generally nothing to worry about when it comes to eye freckles. In most cases, they do not develop into a more serious condition. But of course, close observation and adequate precautions are always beneficial.

Downtown Eyes is a privately owned optometric practice that provides quality eye care and eyewear. Every optician on our team is qualified and experienced in performing eye exams, contact lens fittings, LASIK surgery co-management, eye disease treatment and more. Call us at (612) 333-EYES (3937) or fill out our contact form to request an appointment. We serve customers in Minneapolis.