Monday, May 18, 2009

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!


  1. My doctor says I have an eye freckle really close to my retina. The problem is that I'm only 14, and she says I have to wear sunglasses every time I go outside. Do you think this is a good suggestion? My email is

  2. Good question! 14 is a fun age, hope you are enjoying being a teenager. I think sunglasses are always a wonderful idea. You only get one set of eyes! Plus, they have a lot of really neat sunglasses these days, so find a pair that you like, so that you won't mind wearing them. So yes, wear sunglasses outside. Make sure you follow your doc's recommendations on when to follow up to check the eye freckle as well.

    Hope this is helpful!

    --The Optimist Optometrist

  3. My 9 month year old has a freckle on his left eye, I'm thinking I may need to take him in so they can get a look at it. He was in the hospital for a UTI at 2 days old and got a herpes virus while there. One sore showed up on his eye lid in the same spot where the freckle showed up. Not sure if it's coincidence or something to be concerend about.

  4. Jessi, yes, go get it checked out. Better to be safe than sorry! Especially when dealing with a little one. Good luck!

  5. I have a fairly large eye freckle, it is on the white part of my eye and a small amount of it borders around my pupil, i've had it checked out before and my doctor told me that it was fine but should go see her in a few months. Since i recently moved I have not been able to see her but can remember previously that a portion of it did not outline my pupil. I know i should see my doctor but do you think that is necessarily a bad sign?

    1. it's now 2014. I hope all is well. my daughter has one since birth and recently it has changed so much we can notice it. last check up, doc recommended surgery. it has grown a lot and changed colors. get it check out.

  6. I have a retna detachment and on the same eye I have the freckle my eye doctor told me that it could even change the color of my eye slightly is this true?

  7. I have a very large freckle on my right eye its been there since I was little and right now I'm 15 and I really don't like it, is there any way to have it removed plus my freckle touches where the color and pupil of my eye is and its on the bottom part.

  8. I am hoping you will have some input. I have had the same freckly on my eye for about 10 years(?) I think. I am about 25 now. Recently, the blood vessels in my eye around it have been very prominent. For example, it's 10:22 am here and I got a decent night's sleep and have not consumed any controlled substances, other than caffeine, yet the blood vessels around my freckly are very prominent at the current moment. Is this cause for concern and should I head into the eye doctor?

    1. In the morning it may be because of eye strain at a computer or built up of blood from laying down all night. I have a freckle on my eye also and have had it for the same duration. Still get it checked by your optometrist to clear up any uncertainties.

  9. I've never had a freckle, and I've been told I have really pretty eyes. So when on a date, a guy mentioned that I had not one BUT TWO eye freckles (ofc I freaked out at first) I was disturbed. I have grown up in a phoenix suburb and my eyes have seen a lot of sun...but it was only now that I got something there. It it symmetric, defined, all black, etc....but it's bothering me. Should I be wearing sunglasses more often? And is there a certain time that the sun is stronger. I am an artist, I like my eyes :C

  10. hello Doctor:
    I have a similar situation in the white part of my eye, I am wondering if it can be removed surgically

  11. Do these typically just pop up? I have light green eyes and have never had any spots. Today my eyes are nothing me - possible pink eye from the little one. I looked in the mirror and bam! There are two in my right eye. One is larger and closer to my pupil than the other.

    1. Also from what I'm reading these freckles are something you get from birth or young age. I'm 30 and this literally happened overnight.

  12. Can any freckles in the white part of eye be removed?