Q: At my last eye exam, my doctor found a “freckle” in my right eye. He wants to see me back in a few months. How concerned should I be about this?
A: What you describe is fairly common, but still under 10 % of all patients in general. Like so many pigmentation or melanin lesions, those found inside our eyes are more common in Caucasion people, especially with lighter skin color an light colored eyes.
The difficulty comes in how best to monitor and diagnose these “freckles”. Because the more common benign version is often called a “freckle” this nickname gives it too much of a harmless impression. In reality, our primary concern is how to differentiate this nevus ( it’s medical name” from the cancerous ocular melanoma. They look a lot alike.
These pigmented lesions even have similar appearances to us eye doctors. They are a darker roundish area generally inside the eye where you cannot see them in the mirror. There are subtle differences that sometimes make our differential diagnosis a little easier, but in most cases it requires monitoring over time. We are watching for signs of growth or progression, which is more indicative of melanoma. Comparative ocular imaging and sequential ultrasonic imaging are very useful.
Discovering growth may require a dilated eye exam along with ultrasound evaluation every few months initially. Because both of these conditions are genereally without symtoms, and found in a “routine” eye examination, we usually bring our patient back for dilation and further tests That sounds like where you are at this stage. Early diagnosis and treatment is essential to help prevent vision loss in the eye, or worse, metastasis to other places in the body.
Certainly some people do have symptoms of warning, like floaters or specks in their vision, or a change in their peripheral vision, or even a change in vision clarity. And some forms can cause a “freckle” on the colored part of your eye, the iris, where change may be seen in the mirror. In my experience, symptoms are unlikely for most. And recoginizing these as melanomas is especially important because when growth is observed, spread to other body locations is about eight times more likely.
Clearly, keep your appointments and use extra precautions like faithfully wearing good UV blocking sunglasses….as this can be beneficial in prevention. You may require referral to a retina specialist for consultation as well. So do not be misled by the innocent sounding nickname of a “freckle” in your eye. This is not likely, but being certain this is not an early cancer in your eye is critical.
