Dark Spots On Whites of Eyes

Dark Color Spots On Eyes

"Birth Marks On Eyes"

Ocular Melanosis-Dark Spots on The

White of The Eyes

 

Dark spots that appear over the white areas of the eyes can be usually benign growths of the pigment producing cells known as melanocytes. There are three different type of benign growths:

  1. Freckles (congenital epithelial melanosis)- these are small area of brown pigment close to the iris (colored tissue on the eye).  They are present at birth.
  2. Benign melanosis-small pigmented spots similar to freckles but appearing at middle age
  3. Ocular melanosis

Ocular Melanosis (Technically Congenital Ocular Melanocytosis) presents a picture similar to what is seen in the left image. There are rather dramatic large areas of gray and almost blue discoloration seen on both eyes.

You Should Have An Eye Doctor Evaluate Any Dark Spots On Your Eyes On Your Child’s Eyes

The classification of pigmented spots over the white part of the eyes is somewhat confusing. The sclera is traditionally thought of as the white of the eye. Is is covered by a thin layer known as the episclera. On top of this is the outermost layer, a transparent covering  known as the conjunctiva (which becomes inflamed during attacks of conjunctivitis or pinkeye). Pigmented spots can occur in one or all of these different layers.

Melanocytes are the cells that contain melanin, the pigment that darkens the area. There can be an increase in the number of melanocytes or in the  amount of melanin. The pigmentation changes seen in this eye were present at birth and involve increase numbers of melanocytes in the episclera and possibly the sclera. While there is some disagreement most researchers beleive there is a rare increase for the risk for a melanoma developing on the eye. About 10% of people with ocular melanocytosis will also develop a secondary case of glaucoma. If a patch of pigment manifest on the skin surrounding the eyes. it is called Nevus of Ota.  When a  Routine annual eye examinations are generally the recommended care if no changes are seen.

This may also be referred to as congenital ocular melanocytosis, blue nevus of the sclera, birth marks on the eye, and freckles on the eye. It is not the same as a dis-colorization that develops after birth. This isusually noted as Primary Acquired Melanosis and is localized in the conjunctival tiusse layers.

Fortunately this type of dark spot on the eyes is not a sight threatening condition in the majority of cases



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25 Responses to “Dark Spots On Whites of Eyes”

  1. Phi Nguyen October 26, 2011 at 11:02 pm #

    Hi Dr. Kisling,

    I’m sending this email in correspondence to your article about “Congenital Ocular Melanocytosis”, birthmark on the sclera. I have this condition in my left eye, same eye has a darker iris. Since birth these spots have not changed in color or size. I was wondering if there are any known treatments to get this removed or at least cosmetically appealing. I have also met many people around the globe, that would also benefit if there was a treatment available. Any advice would be greatly appreciated.

    Thanks,
    Phi Nguyen

  2. admin November 14, 2011 at 8:54 pm #

    Hi Phi,

    The only treatment currently available would be a custom tinted cosmetic contact lens. This could help eliminate any cosmetic concerns, but I have always thought the appearance was unique and attractive in its own way.

    Best Wishes

  3. Kai Evjen November 19, 2011 at 11:48 am #

    I wish to get in contact with Phi Nguyen to talk about this issue. My daughter`s right eye has about 50 % grey color in the sclera area. I would like to now if he have any treatment to refer to.

    Kind regards
    K. Evjen

    kevjen@me.com

  4. Karina February 11, 2012 at 8:27 pm #

    today i noticed these in my 2 year old daughter’s eyes should I be concerned and what should I do? Also should i see a normal eye doctor or a specialist of some sort?

  5. admin February 20, 2012 at 3:32 pm #

    Hi Karina,

    Please let me know what you noticed, I am not sure which thing you are referring to.

    Best Wishes

  6. julita February 26, 2012 at 2:32 pm #

    hello
    today i noticed dark,grey,round patches on my 5,5 year old girl’s eyes,especially left one(looks like they surround the iris) and I am sooo worried as I have read that it may be cancerous!I noticed that my husband got few as well but less and not as strong in colour.Please,tell me more about it!thank you

  7. admin February 29, 2012 at 9:40 pm #

    Hi Julita,

    Look for an older picture and take it to your eye doctor so they can examine it under magnification-probably you are noticing something that has been there since birth. In light skinned individuals there is a significant increase in lifetime risk for melanoma. This risk is still only 1 in 400 but in the general population it is 1 in 13,000. In darker skinned people the risk is much less.

    Best Wishes

  8. Paula March 26, 2012 at 12:26 pm #

    Hi. My 14 month old son just went to see an ophthalmologist for the grayish brown speck on his left sclear (close to his iris) and far left (almost unnoticeable) on his right eye. The doctor said he has ocular melanosis and told me to look up for information online. Since Friday, I’ve been looking for information and kept finding such negative news- common in cairn terriers, cancerous, glaucoma, etc.

    Honestly, I’m very upset about this. None of my famil y has it. I don’t think my fiance’s family has it, either.

    Is there any way I can prevent it from getting worse? Should I buy him sunglasses? Caps and hats to keep the sun away from his eyes? Does this mean he cannot play touch sports (i.e., football) due to pressure that might affect his eyes?

    Will he go blind someday? One website says yes, and that it usually gets worse after his first decade of life.

    The news is downright disappointing, and I feel helpless because there isn’t much information about ocular melanosis.

    :(

  9. admin April 25, 2012 at 4:59 pm #

    Hi Paula,

    While there is an increased risk for glaucoma and melanoma cancer in the eye, it is unlikely that your son will ever go blind. About two of every thousand caucasians who have ocular melanosis will develop a melanoma. These are usually very treatable if detected at an early stage. Darker skinned people have a much lower incidence of conversion. About 10% of people with ocular melanosis will develop a form of glaucoma from the extra pigment that is being produced. This is also treatable. There is no proven link between this type of melanoma and UV exposure from sunlight, but I would recommend using glasses and sun wear for him when he is outside and wearing hats is a good idea for all of us. Other than that, the best protection is regular, preventative eye check ups every year, or sooner if he notices any changes in his vision. Talk to your eye doctor about the recommended frequency for eye exams. There is no added concern for playing sports or any type of pressure on the eye. Since a high percentage of ocular melanomas develop from preexisting pigmented spots, this can lead to some confusion. That only means what it says, the reverse is not true. Only a very tiny percentage of preexisting pigmented spots on the eye ever turn into melanomas. Your child should lead a healthy normal life with great vision.

    Best Wishes

  10. julita May 21, 2012 at 10:30 am #

    hello
    I wrote to you few months ago
    thank you for the reply!
    we had appointments with 2 opthamologists and they said that it may be thinning of sclera,other that it may be a blue sclera and optician said it is pigmentation!!!! who should I believe?
    the patches are grey and actually not as dark as on the picture above.they are irregular,some with a vain with a vein dot in the centre!the patches are separately.my child is half iranian but he does not have any problems like that.Ohh..my 14 moths old girl has few of this grey patches as well but they don’t have that irregular,sharp shapes as with older gilr…it looks more like split drink and with older girl as if you were putting stick in that split water little bit! I am sorry for this very poor explanation.the colour is light grey abd the paches are tiny and some bigger.mainly with those veins.month or two ago I noticed that at home her sclera looks a bit blue but outside with normal light there is nothing!please,tell me if this is another disease or just thinning! thank you,julita

  11. julita May 21, 2012 at 10:36 am #

    i am sorry I meant that my child is half iranian half caucasian but my husband doesn not actually have any grey patches like that as i thought before!
    thank you

  12. Nandita May 22, 2012 at 12:52 am #

    I am 21years old and I have the exact same condition in my left eye with a coverage of 80% on the sclera. I tried the cosmetic lens option, but since i have the condition all over my eyes it seems impossible to cover it up and was still considerably prominent despite increasing the lens size to its maximum. I would like to know if there’s a permanent solution to this problem, like if there’s a chance to remove the sclera and replace it, maybe?. Please notify me.

  13. julita May 23, 2012 at 7:37 am #

    hello again
    I am writing as I am very worried about my child!
    we had an appointment with ophthalmologist yesterday and he said that first he could not see the blue hint to my child’s sclera but then I asked him to have a look again in different light and he admitted that there is a blue colour in her sclera but there is nothing to be worried about!!! maybe it is pigmentation….but the blue colour clearly is not a pigment,even I can see that!
    does is mean that she is developing a disease called blue sclera? how can I be sure that if the disease is bone disease it will not progress from mild to worse?!
    please,give me some details
    thank you

  14. admin May 30, 2012 at 1:54 pm #

    Hi Nandita,

    There is not a procedure available to the public yet but probably one is on the way, In 2005 the first procedure referred to as Flipped Scleral Flap Surgery for Reduction of Ocular Pigmentation in Oculodermal Melanosis was performed on six pateints. Flap-like layers were created in the scleral tissue and it was replaced more or less upside down. Reportedly, all patients had iFlipped Scleral Flap Surgery for Reduction of Ocular Pigmentation in Oculodermal Melanosis
    roved cosmetic appearance but some discoloration remained.

    This year (2012) a paper described a series of procedures done between 2005 and 2009 on 49 patients. I beleive the same scleral flap surgery was used. The results were generally good with a few complications including temporary increases in eye pressure readings. If you travel out of the country they might be able to enroll you in a future treatment. The Doctors and center are as follows:

    Kim JY, Hong JT, Lee SH, Lee J, Kim MJ, Tchah H
    Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.Asan Medical Center (Seoul Choongang Hospital)
    388-1, Poongnap-dong, Songpa-gu, Seoul
    Tel: 02-2224-3114

    Other than that there is a patent that someone has applied for using low power laser pulses to whiten the sclera. I have no idea if there are any clinical studies planned for this yet but it would be less invasive if it works.

    For now you might want to recheck on contact lens options. Soft contact lenses do not come in as large of a diameter as the rigid gas permeable scleral contact lenses. Scleral contact lenses should cover most of the pigmented regions so if you tried a soft custom tinted lens you should consider looking into gas permeable scleral lenses. They tend to be fairly comfortable due to the larger size (It sounds backwards but it works out that way).

    Best Wishes

  15. admin May 30, 2012 at 1:54 pm #

    Hi Nandita,

    There is not a procedure available to the public yet but probably one is on the way, In 2005 the first procedure referred to as Flipped Scleral Flap Surgery for Reduction of Ocular Pigmentation in Oculodermal Melanosis was performed on six patients. Flap-like layers were created in the scleral tissue and it was replaced more or less upside down. Reportedly, all patients had iFlipped Scleral Flap Surgery for Reduction of Ocular Pigmentation in Oculodermal Melanosis
    roved cosmetic appearance but some discoloration remained.

    This year (2012) a paper described a series of procedures done between 2005 and 2009 on 49 patients. I beleive the same scleral flap surgery was used. The results were generally good with a few complications including temporary increases in eye pressure readings. If you travel out of the country they might be able to enroll you in a future treatment. The Doctors and center are as follows:

    Kim JY, Hong JT, Lee SH, Lee J, Kim MJ, Tchah H
    Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.Asan Medical Center (Seoul Choongang Hospital)
    388-1, Poongnap-dong, Songpa-gu, Seoul
    Tel: 02-2224-3114

    Other than that there is a patent that someone has applied for using low power laser pulses to whiten the sclera. I have no idea if there are any clinical studies planned for this yet but it would be less invasive if it works.

    For now you might want to recheck on contact lens options. Soft contact lenses do not come in as large of a diameter as the rigid gas permeable scleral contact lenses. Scleral contact lenses should cover most of the pigmented regions so if you tried a soft custom tinted lens you should consider looking into gas permeable scleral lenses. They tend to be fairly comfortable due to the larger size (It sounds backwards but it works out that way).

    Best Wishes

  16. tasha December 29, 2012 at 7:39 pm #

    My daughter has these spots . I will look into what it is a little more . you do not go blind from glaucoma unless untreated there is two types open and closed angle one you just monitor the other you have to use eye drops . Im am still concerned about my daughter she is only 2 I just noticed this tonight.

  17. admin January 2, 2013 at 12:05 am #

    Hi Tasha,

    You should try to get her to have preventative eye exams every year if at all possible- not always the easiest thing to accomplish with people that age. You are right, it is fairly uncommon for people to go blind from glaucoma when they are diagnosed and treated at early stages. The unfortunate thing is that 50% of vision can be lost before people are aware of a defect and that is not an early stage. Most people with glaucoma will not have any symptoms until significant vision is already lost so preventative eye exams are important. Narrow angles that predispose people to angle closure glaucoma can be monitored without treatment moist of the time, but once it starts to close it is essential to have treatment. Mildly elevated pressures in the eye that show no signs of glaucoma defects can also be monitored without treatment in many cases, but if signs of damage occur or there are multiple risk factors (advanced age, maternal family history, cardiovascular disease, diabetes, smoking, African American populations, and others) treatment is best started earlier.

    Best Wishes

  18. Shayla March 27, 2013 at 6:41 pm #

    I am 19 years old and a Native American. My right eye looks just like the picture above and my left eye has little specks of the blue/gray tint and also above my right eye it looks like I have blue eye shadow on. A lot of people think I am abused. Haha. I wear glasses instead of contacts because if I don’t it brings more attention to it. My parents told me I was born like that and the doctors then said it would go away but it never has. I decided this evening to look up information on what it was all about. I go to the eye doctor every year and get my glasses adjusted to a lil stronger and all eye doctors only ask if it affects my vision which it doesn’t, both eyes I feel have the same vision. Should I be worried about all of this? Or what do you think will happen in time? Do you think I should go to people who study the eyes?

  19. Dr. Kisling March 30, 2013 at 8:48 pm #

    Hi Shayla,

    Don’t worry about it. Do have your eyes checked every year. With the advent of cell phones with reasonably good cameras at our fingertips all the time, you should have someone take some pictures of each eye and store them somewhere online so they will always be available if you think it has been changing at some point in the future.

    Best Wishes!

  20. Jacky August 6, 2013 at 2:40 pm #

    Just to put peoples minds at rest.I am 45 & was born with these marks in both my eyes,mostly my left eye.when j was a child i was sent to an eye clinic because of this, they wernt really sure what it was & put it down to me being mixed race.I learnt years later what it was & have never had 1 single problem with my eyes & still have perfect vision.so try not to worry too much.

  21. Dr. Kisling August 11, 2013 at 4:57 pm #

    Hi Jacky,

    Thanks for your comments. Most of the time you are right. If there is a family history of inheritable colon cancer or atypical bear tracks they do become much more critical in making a timely and life saving diagnosis. Unfortunately I believe most of us will only see typical bear tracks during the course of our careers since atypical ones are rare occurring in about 1 in 100,000 people. In all likely-hood that makes all of us (including me), be much more cautious than we would need to be if there was a clearer way to differentiate the typical from the atypical. Hopefully new technology will take care of this at some point in the not to distance future. I believe we have the type of technology already and only need to develop affordable new ways of recording and analyzing data.

    Best Wishes!

  22. mariana September 4, 2013 at 2:38 pm #

    my eyes look just like the picture above on both eyes i just thought i was special :)

  23. Luka September 13, 2013 at 2:31 pm #

    Hi,
    I have a little grey spot on my left eye, and i just wanted to know if this is dangerous like a mole or if it’s just like a birt mark?
    Thank you.

  24. Dr. Kisling September 21, 2013 at 6:48 pm #

    Hi Mariana,

    It is pretty cool looking and you are special with or without it! Just make sure to have your eyes checked every year.

    Best Wishes!

  25. Dr. Kisling October 6, 2013 at 5:59 pm #

    Hi Lika,

    The best rule of thumb is anything that is changing, getting larger, has irregular margins, or seems to have a blood supply or any signs of bleeding needs to be checked out. You can always have a friend take a high resolutions picture on a cell phone and check it every month or so for a while to see if it has changed if you can’t get in to see someone. Cell phone cameras have gotten pretty good these days and almost everyone has access to one. You can even record the settings and enlargement and measure the size if you want for comparison. With larger areas like the picture it really should be followed about once a year.

    Best Wishes!

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