You can get freckles in your eye? Seriously?

I had a friend ask me about freckles in the eye, so my second topic for this blog is going to be (drum roll again…) Ocular Nevi. That’s just a fancy term for eye freckles. The singular form of the word is ocular nevus, in case you want to impress your friends with your wealth of eye knowledge.

Yes, you can get a freckle in or around your eye, and there are certain things we look for when we see them.

Disclaimer time: An eye freckle is often something that does not need treatment… HOWEVER, there are some freckles that need to be monitored by a specialist, or even removed. Your eye doctor will let you know what you should do. SO GO TO YOUR EYE DOCTOR, I promise again that we are nice!

I’m not going to go into freckles on your eyelids or around your eyes; let’s save that for another time. I do want to talk about freckles on the white part of your eye as well as retinal freckles.

So let’s talk about the freckles you can see yourself… those on the white part of the eye (conjunctival nevus) or the colored part of the eye (iris nevus). Here are some pictures of freckles that you can see yourself in the mirror:

You can also get freckles that you won’t see in the mirror. A choroidal nevus is one that you cannot see yourself in the mirror because it is behind the iris. We can get pictures with a retinal camera so you can see your freckle though, and they look like this:

So which freckles are no big deal, and which ones do we worry more about? We use this ABCDE thing to decide if a freckle worries us more or less:

A is for Asymmetry: You know how they say the more symmetric your facial features are, the more beautiful you are? We feel the same way about eye freckles. If the right is the same shape and size as the left, and the top is the same shape and size as the bottom, then we have a more safe (and beautiful) freckle.

B is for Borders: I don’t mean the bookstore, although I do have a gift card to use there… any good book recommendations? We like the edges of the freckle to have distinctly defined borders. Uneven, irregular borders make us worry more.

C is for Color: If you have a green freckle, you might be from outer space. Just kidding. We like freckles to have a color that is the same (uniform) throughout, rather than a bunch of different shades of colors throughout.

D is for Dimensions: Bodybuilders might tell you that bigger is better, but that’s not the case when we’re talking about freckles. Your eye doctor will measure your freckle and compare it from visit to visit.

E is for Elevation: We like freckles to be nice and flat instead of raised. Your eye doctor will watch your freckle to determine if it is flat or elevated.

So, now what?

When I see a patient with a freckle, and it is a symmetric, even-colored, small, flat freckle with defined borders, then I do the following:

• Take a picture of the freckle. (Say, “Cheese”!)


• Measure the freckle


• If the patient was here before, compare it to last visit


• See the patient back (usually in 6 months) to take pictures again and look for any changes
  

If the freckle worries me in any way, or if I see changes in a freckle from a previous visit, then I will send the patient to a specialist for further evaluation. The specialist may do a scan of the eye or sometimes a biopsy.

Healthy living time! Regular screenings with your eye doctor can assure that your eyes stay healthy. If we see a freckle, we will document everything we see so that we can make future comparisons. Knowing exactly what a freckle looks like at a certain point in time can make it much easier to properly diagnose your condition.

By the way, I just had a patient with a choroidal nevus. His wife was in the exam room, and since the nevus was in the left eye, she named the freckle “Lefty.” An appropriate name, I suppose.

Hope everyone found this helpful... my next topic I think will be something on either sports or sun protection... Have a BEAUTIFUL week!