A freckle is an area of skin or epithelium that has more pigment than the surrounding area. Typically, a freckle is thought of only on the skin but there are different forms of eye freckles that can form including on the colored part of the eye (iris), the white of the eye (conjunctiva), or on the back of the eye (retina). These freckles in the eye are usually benign findings and do not affect vision in any way. It is possible for one of these freckles to transform into a malignant form of cancer therefore regular monitoring with comprehensive eye exams is needed.
Pigment in the Skin and Eye
The skin contains a pigment that gives the skin its color. This pigment is called melanin and is found in all individuals.
The difference in skin color between individuals is based on the amount of melanin in the skin.
Similarly, the iris – the colored portion of the eye – has melanin within it. The difference in eye color is also caused by the varying amount of melanin in the iris.
What Causes Eye Freckles?
A freckle is an accumulation of melanin in an area that is more than the surrounding area. On the skin, this looks like a small area that is a darker brown than the rest of the skin in that area.
In the iris, a freckle will look similar. It will be an area that appears to be a spot of darker brown in a lighter eye – whether it is blue or light brown.
On the conjunctiva, a freckle will stand out as brown pigment against an otherwise white and clear background. These types of freckles are caused by melanin that migrates into the conjunctiva which typically does not contain melanin.
In the retina, a freckle is also caused by an accumulation of melanin within the epithelium of the back of the eye.
Iris Nevi
A freckle in the iris can also be called an ephelis. This is a fairly common finding and is almost always completely benign.
These freckles are flat, brown patches that are frequently in the lower part of the iris towards the nose.
An iris freckle can cause problems if it grows and transforms into a malignant tumor or if it grows into the drainage system from the front of the eye.
Freckles in the Conjunctiva
A freckle in the conjunctiva is also called conjunctival melanosis. These freckles may appear as brown patches or swatches of dark pigment.
Again, these freckles are mostly benign findings without any risk of complications.
If conjunctival melanosis develops in a younger person with less overall melanin, it can predispose them to develop a type of skin cancer within the eye.
Choroidal Nevi
A freckle in the retina is also called a choroidal nevus. These freckles are only visible in an eye examination by an eye doctor or using special photography.
A choroidal nevus is a benign condition but must be monitored as it can transform into choroidal melanoma which is malignant cancer that can affect the entire eye and brain.
When Should You Be Concerned About a Freckle?
The biggest risk with any freckle in the eye is that it transforms into a melanoma in the structure in which it is located.
Melanoma is a malignant cancer of epithelial tissue and requires treatment using radiation or surgical excision.
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