You’re probably familiar with freckles on your skin, but did you know you can also get freckles in your eye? An eye freckle is called a nevus (“nevi” is the plural), and different kinds of freckles can occur on different parts of the eye.
While usually harmless, they do need to be monitored by a doctor because there’s a small chance they can become a type of cancer called melanoma.
What Are They?
There are two types of eye freckles. One is technically known as a nevus. They’re similar to moles on your skin. “Nevus” means “mole.”
Some of these nevi (the plural of nevus) are easy to spot. But others are hidden in the back of your eye, where no one but your eye doctor will ever see them. They have different names depending on where they are:
- Conjunctival nevus: On the surface of your eye
- Iris nevus: In the colored part of your eye
- Choroidal nevus: Under your retina (in back of your eye)
A conjunctival nevus is a pigmented lesion on the white part of the eye, known as the conjunctiva. These nevi make up more than half of all conjunctival lesions and usually appear in childhood.
When the eye freckle is on the iris (the colored part of the eye), it’s called an iris nevus. Approximately 6 in 10 people have one.
Research has associated increased sun exposure to formation of new iris nevi, but more studies need to be done. They’re always flat and don’t pose any risk. These are different from raised masses on the iris or iris melanoma.
When a doctor tells you that you have an eye lesion that needs to be followed, they’re likely referring to a choroidal nevus. This is a flat pigmented lesion that’s benign (noncancerous) and located in the back of the eye.
According to the Ocular Melanoma Foundation, roughly 1 in 10 people have this condition, which is basically an accumulation of pigmented cells. While choroidal nevi are generally noncancerous, there is a small potential that they can become cancerous, which is why they need to be followed by a doctor.
Nevi can be yellow, brown, gray, or a combination of colors. They’re made by special cells called melanocytes, which give your skin and your eyes their color. Those cells are usually spread out, but if enough of them clump together, they form a nevus.
The other type of eye freckles are called iris freckles. These are tiny flecks in the colored part of your eye. They’re more like the freckles on your skin than moles -- they’re only on the surface of your eye and don’t affect its shape. About half of all people have iris freckles.
Some types of nevi form before birth, while iris freckles are more likely to show up in older adults.
What Causes Eye Freckles?
Doctors don’t know why some people have them and others don’t, but a couple of things may affect your chances:
- Race: Choroidal nevi -- in the back of your eye -- are much more common in white people or people with lighter skin tones than in black people.
- Sun exposure: It’s possible that sun damage might raise your chances of nevi, and there’s evidence that iris freckles are related to being out in the sun. A 2017 study found that people who spent more time in the sun had more iris freckles.
Do Eye Freckles Need Treatment?
Most eye freckles are benign, but if you have one, it needs to be monitored by an eye doctor with frequent exams, usually every six months to a year, to document the size, shape, and any color changes of the freckle.
While there are associations between nevi (particularly choroidal and iris) and UV light, more research needs to be done to clarify the role of the latter. However, wearing sunglasses outside might help reduce the risk of complications with nevi.
If a nevus does need to be removed due to any complications, melanoma, or suspicion of melanoma, this is done with surgery. Depending on the individual situation, local excision (using a very small blade) or argon laser photoablation (using a laser to remove tissue) are possible options.
See Your Doctor
If you’ve noticed a spot or freckle in your eye, it’s probably not a problem. But it’s important to get it checked out by an eye doctor (optometrist or an ophthalmologist).
During your appointment, your doctor may want to take a photo of the freckle and possibly do some imaging scans to look at it more closely. You may need to go back every 6 months or so to make sure the freckle hasn’t changed (like growing bigger). If it still looks the same after a few years, you can probably switch to yearly checkups.
Other reasons to see an eye doctor include:
- A freckle in your eye that’s grown or changed its shape or color
- Eye pain
- You see flashing lights
- Other changes in your vision
To protect your eyes, wear sunglasses that block at least 99% of UV rays when you’re outside. While we don’t know for sure, sunglasses might lower of the chances that a harmless nevus will turn into melanoma. And they definitely lower your odds of getting cataracts and other serious eye problems.