So you have been told by your eye doctor there is a freckle in your eye. Should you be worried? It could be a number of things but the most likely are choroidal nevus (benign choroidal melanoma) or CHRPE (congenital hypertrophy of the retinal pigmented epithelium). Both conditions are usually benign and not a serious problem. They both need to be monitored to make sure they are not malignant melanomas.
Congenital hypertrophy of the retinal pigmented epithelium (also known as halo nevus) is a pigmented, well demarcated dark spot inside the back of your eye on your retina. Though size varies, it is convenient to think of it as about equivalent to the top of an eraser on a pencil. It is an accumulation of increases in pigment in the cells of the retinal pigment epithelium cell layer. This is hypertrophy, or an increase in the size but not the number of cells. The blood vessels underneath it atrophy also which results in a small blind spot which you are not capable of perceiving. While there are often changes over time; it is mostly a stable, inconsequential change and CHRPE can be thought of like a freckle on your skin. The difference is you can’t observe it for any changes like you can a spot on your hand, so serious conditions can advance past the treatable stages. On rare occasions a halo nevus can change from a normally flat surface and develop elevated nodules. The formation of these adenoma tumors are very rare but something eye doctors do check for on an annual basis. Usually no further tests are required other than eye exams with your eyes dilated in 3-6 months after first observation, then annually there after.
CHRPE also occurs in a form called “Bear Tracks.” Bear tracks are multiple dark spots in the back of the eye that look like little bear footprints. They frequently occur in conjunction with a condition called familial adenomatous polyposis and require further testing for colon and rectal cancer. This can be due to a dominant gene that is often seen to run in families as an predisposition to colon cancer. Bear Tracks may be seen years before the cancer occurs so they may be a valuable preventative sign to your optometrist. Bear tracks may require a referral to a Gastroenterologist Doctor for further evaluation. Not every patient with Bear Tracks will get colon cancer, but it is more likely if they are large, present in both eyes, and there are more than 3 or 4 spots in each eye. Isolated single CHRPE spots are not associated with Familial adenomatous polyposis or an increased risk of colon cancer.
Trauma to the retina whether from injury or infections in the eye can cause dark spots similar to CHRPE but they are irregular in shape. They are due to an actual increase in the number of retinal pigment epithelial cells which is called hyperplasia. The primary concern in this case is to monitor the condition that caused it. If it is an infection in one of the layers of the eye it could recur at a later date.
A choroidal nevus is indeed like a nevus (freckle) but it is occurring in the choroid, the level below the retina which supplies circulation to the retinal tissue. These appear as round, grey, usually flat spots and are very common occurring in up to 30% of the population. They are also referred to as benign choroidal melanomas, though they are not true melanomas. They are due to an increase of melanocytes in the choroid. Melanocytes are the cells that hold pigment. They are found in our skin and in parts of the eye. The retina does not have melanocytes, it has pigmented epithelium cells instead. A choroidal nevus is usually flat, but does appear more similar to melanomas in the choroid due to being located at the same level below the retina. They require closer observation and sometimes further testing to make sure they are benign spots. Any nevus can undergo transformation to a melanoma but it is very rare.
Testing to diagnose any new spot observed can include ongoing observation, optical coherence tomography techniques of imaging the layers of the retina, digital imaging pictures, and fluorescein angiography of the ocular fundus. A dilated exam of the inside of your eye (fundus) annually is the only technique that allows eye doctors to adequately detect most of theses spots. Although this can be mildly uncomfortable causing light sensitivity and mild dry eyes, it should be done by you optometrist. Frequently patients have not had their eyes routinely dilated in the past so when your optometrist finds a new spot or freckle in your eye it may have been there unchanged for years. You can be reassured in knowing that the large majority of the time it is completely innocuous and only needs to be rechecked once every year for any changes. In areas with large amounts of UV exposure like Northern Colorado, sunwear with UV protection can help reduce the risk of melanomas. There is some controversy over UV exposure and cancer, and some suggestions that vitamin D may reduce certain type of cancer such as adenomas and the colon cancer seen associated with bear tracks. In the future, sunwear and moderate exposure to UV could become the recommendation.
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Our 13 year old daughter was seen yesterday by her optometrist for reading glass lens reassessment and bear tracks were noticed, but not bilateraly. Not vascular, nor raised. My mother succumbed to adenocarcinoma of the assending colon at age 52 in 1978. I am out of my mind here!
Author
Hi Demetrius,
Usually familial autosomal Polyposis is associated with bilateral bear tracks and they are atypical in appearance, being more oval shaped with more pigment changes beside their borders. I would not rush to any conclusions since you do not know (I am presuming) whether your mom’s carcinoma was an inheritable form. You should let your family doctor know and ask your optometrist to send them a report. They can help you decide if there is a need for any further diagnostic testing. There is a genetic test using a blood sample for mutations known to cause FAP in the APC and MYH genes. To my understanding, the APC gene is dominant and would only be passed on if it was present in either parent which you would probably know by now. From what you have said there is probably not enough evidence to warrant genetic testing or a sigmoidosocpy exam, but I will leave that to the docs who work and specialize in the area.
Best Wishes!
My daughter has a freckle in her eye. Should she take an eye vitamin?
Author
Hi Sarah,
A freckle does not really warrant any supplementation. You are best off helping her develop good sun hygiene practices; avoiding the peak hours of sunlight, wearing sunglasses outdoors, and wearing brimmed hats outside. Sunglasses should never be blue as blue light can contribute to damage to the retina. The only concern is a freckle transforming to a melanoma. This is a very rare phenomenon so overall rest easy and encourage her to have an annual dilated eye exam.
Best Wishes!
I have a freckle on my eye and sometimes it hurts is that bad?
Author
Hi Minga,
If you have discomfort associated with it you should definitely have it checked by an eye doctor.
Best Wishes!
Hi Dr. Kisling my doctor found bilateral CHRPE. My mayternal grandmother has H/O colon Ca. I’m 45 yrs. old. Thank-you!
Should I be concerned? I’m worry.
Author
Hi Claudia,
If there were multiple CHRPE you should be checked for familial adenomatous polyposis (FAP). Hae a colonoscopy test done to rule this out. Ask your family doctor for a referral, they should be happy to provide it. If present you need to be followed and treated and you should be fine. If not you will sleep better.
Best Wishes!
Hi,
Had a routine eye exam today as a walk in at an eye clinic (needed an exam to get new glasses). Optos Plus picked up a small ‘freckle’. Doctor said nothing to worry about and have it checked in a year. I’m still a bit concerned…should I have it checked again sooner?
Thank you.
Lynn
Author
Hi Lynn,
As long as you felt the doctor was competent you should be fine. Anything reportedly new I do like to recheck in 3-6 months, but usually it has been there for years and just not picked up by prior eye exams. There are some distinguishing characteristics that I see sometimes that make a year perfectly reasonable.
Best Wishes
Hi Dr. Kisling,
My current ophthalmologist recently discovered a benign choroid freckle in my left eye that was initially discovered 39 years ago by another ophthalmologist at the Cleveland Clinic using sophisticated equipment. My current doctor could not see it until his center recently purchased a more sophisticated photography system. Does the fact that my nevus (freckle) is almost 40 years old with no apparent change indicate a reduced risk of turning into a malignant melanoma? Thank you.
I forgot to mention that all other eye doctors between the visit to the clinic 39 years ago and my latest ophthalmologist did not report seeing the nevus as well.
Author
Hi David,
Statistics are funny things. Probably the rate of conversion is the same regardless of the history. On the other hand, common sense would tell you that it is not a misdiagnosed melanoma or perhaps even one that has a high propensity to transform into a nevus. After 39 years I would not be much concerned about it other than an annual exam. The issue with a nevus in the eye is that you can’t see it to monitor for any changes like you can on the skin. In the rare case a freckle on your skin turns into skin cancer you probably would notice it fairly early on. In your eye you are dependent on having someone else monitor it. That being said, it is a pretty rare event.
Best Wishes!
Hi Dr. Kingsling
I had corneal crosslinking done in left eye to treat Lasik induced Ectasia. I had a bad reaction to the UV light that was shined in my eye for 30 mins in an effort to strengthen cornea.
Since this procedure I have developed a ‘freckle in back of eye’ but was not told much about it. My concern is that this procedure caused the freckle and I am now at a higher chance of malign transformation.
Any input is appreciated !
Author
Hi Scott,
Corneal Cross Linking is done with UVA. UVA activates melanin (the colored pigment) that is already present and the effect is temporary. UVB would be more of a concern if it was being used as it does cause the creation of new melanin.
The other factor to consider is the dosage you receive during the procedure. The total dose is supposed to be about the same as a full day in the sun. That is just on the surface of the eye. The riboflavin drops help decrease the amount of exposure by 95% by the time it reaches the back of the cornea. Then it is reduced by half again as it passed through the lens. At least in theory, you are probably getting a dose of less than .08 milliwatts per square cm. At 8 ten thousandths of a watt you probably don’t have much to be concerned with. As best as I can figure you get a dose equal to less than 10 minutes spent outdoors.
The third factor to consider is the actual wavelength of ultraviolet light used. The wavelength used (370 nanometers) is in the low end of damaging radiation for UV. It is felt that once the UV gets partially through the cornea there is inadequate energy to cause cellular damage.
While it is possible that could be the tipping point, it is much more likely that something was found that had already been present for a while. Usually the rate of transformation of a nevus to a melanoma is rare. The best estimate I could find is about 1 in 8800. I think it is probably less than that. Something like 5-7% of the population will have a freckle in the back of their eye. The biggest issue is that you can’t see changes like you can if it occurs on your skin. That mean you need to have your optometrist monitor it just to make sure.
Best Wishes!
My 15 year old son was just told that he has a 4mm freckle on his eye. one year ago he had a full exam and there was no freckle then. They are sending him to a specialist but the doctor said it is just a precaution. can a 4mm freckle come in one year? if so, does this mean it is potentially something more?
Author
Hi Laura,
A 4mm freckle can occur in one year. Frequently it was just not seen the prior year, that is pretty easy to do. We are always concerned about the possibility of a melanoma in the beck of the eye. It is a good idea to have an opinion from a specialist in a case like this, just to be sure.
Best WIshes!
I had a routine eye exam done 2 weeks ago. It had been 5 years since my last exam. I informed my eye doctor that about a month ago I started having a lot of floaters in my right eye and I often seen shooting light out of the side of my eye. This appeared to start after shoveling a lot of snow. I also have been having shooting sharp pain for 2-3 weeks in my right eye. The eye doctor discovered a cataract in my right eye. She sent me to their other vision centre to have an eye test done to have my pupils dilated. My eye doctor told me that if I didn’t hear from her in a couple of days that would be a good thing. Sure enough three days later she called me twice, however I wasn’t at home. She called again the following day and informed me that her and a colleague noticed a “freckle” behind my left eye. I was sent back for another test using eye drops which stung my eyes and dilated my pupils. That was on Wednesday and I haven’t heard any results yet. I am out of my mind with worry!!! Last year my first cousin ( 10 years older than me ) went for a routine eye exam. A tumor was discovered behind her eye and she died 6 months later. I also had an Aunt and another first cousin die from brain tumors and now my first cousin’s young adult son has been battling a brain tumor for a year. All of these relatives are on my Mom’s side! I am absolutely terrified! It’s all I can think about . I am 53 years old and have never had any trouble with my eyes except this sharp right eye pain. I have bad migraines on a regular basis for years and although there is nothing I can do to relieve these migraines I accept them for what they. This “freckle”, this uncertainty,has me sick with worry! Any input you can provide would be very much appreciated.
Author
Hi Carole,
Hopefully you have a better diagnosis by now ( I am a little behind in my replies). It sounds more like traction from the vitreous ( the fluid inside the eye). As we age this tends to change from a jello like structure to a watery structure, and then it tugs on the retina where it is attached. Eventually it causes a Posterior Vitreous Detachment and is no longer a concern. Occasionally it will result in a detached retina which is an emergency that needs to be fixed right away. Usually the flashes of light occur after sudden head movements like you would do when shoveling snow. Regardless of the casue you need to be closely followed by your eye doctor.
Best Wishes!
Posted a comment in April and my post is awaiting moderation – I guess maybe there will not be a reply?
Author
Hi Polly,
I can’t find a post from April. Sorry, you might submit it again if you would like.
Best Wishes!
I have been told I have several freckles on my right retina and one on my left retina. Is it OK to have several lesions or is it a sign that I am more likely to develop ocular melanoma. Specialist does not seem that concerned and will see me in 6 months time. I am 64 years old, and am worried
Thank you.
hello, I’m 17 and all day my eye burned and wouldn’t stop watering, I thought I may have just rubbed perfume in it on accident, so I washed my eye out and it didn’t work. when I got home from school I looked at with closely and noticed a small dark brown or black dot on the lower part of my iris, I have hazel eyes. it looks more like it sits on the outer layer of my eye, but wont move at all when I tried to remove it. I don’t know what it is or even if its an eye freckle, and I’m worried.
thank you 🙂
My daughter is eight and was born with a coloboma of the left eye, no one in our family history ever had a coloboma. She was conceived through IVF and we understand a baby conceived this way can be subject to mutations. She was checked as a newborn and also has annual eye exams to make sure there are no problems with her vision and that no changes are noted. We have never had an eye exam show any abnormalities until yesterday. They found “bear tracks” on her left eye. She had three on that eye. Her dr is very thorough but I’m still concerned. He wants to see her again in six months to document any changes. When she was a newborn we were referred to the Eye Foundation at UAB by the dr we currently use. Should we return to see them instead of waiting the six months for a follow up? Maybe they have more updated equipment than our dr does now. He could see the “bear tracks” during the eye exam but his equipment could not find them when they tried to photo the spots. I hope I am overreacting but am very concerned.
Author
Hi Amanda,
You are probably OK waiting the 6 months. These are typically a fairly benign finding. They can be associated with familial adenomatous polyposis. You should make sure her pediatrician is aware of this finding so she can be appropriately screened.
Best Wishes!
Author
Hi Taleah,
It sounds like you might have a foreign body ( a particle of something) embedded in the clear cornea covering your eye. You should have it checked since if this is the case it could lead to an infection.
Bets WIshes!
Hi…I’m 32 years old had recently went to my opticians. Last time I went was a little under 2 years ago. I was told there was a freckle in the back of my left eye and was referring me to hospital. This has never been seen before? Even after a thorough check about 5 yrs ago due to neuro logical issues? I understand these freckles are common…do they just appear at any age? My optician didn’t have much to say on the matter on the day just that he wanted to check it out? I haven’t really thought about it since but my apt at he hospital is in a few days and I suppose the anxiety is kicking in?
Author
Hi JJ,
It is easy to miss a freckle during a routine eye exam so there is no guaranty it was not present in the past. They also can develop at any age, just like freckles on the skin. Unlike a freckle on your arm, you cannot see it to monitor if it changes size or character inside your eye. Even though the conversion rate to melanoma is very rare, that is why we always keep a close eye on them inside the eye, you just can’t self monitor.
Best Wishes!
I have been referred to an eye hospital. My optician said this was due to the nerves at the back of one of my eyes. Apparently this appears as a circle and should have a solid line around it. Apparently mine is sqiggly on one side. Is this anything to worry about? I am just wondering what the possible causes are?
Hi, I went to a new eye doctor today and was dilated for the first time in at least 15 years. I have always had a freckle on the left eye that has been there since I can remember… but today she showed me that there was one on the interior on the right eye. My biggest concern is that I had a mole removed two years ago just at the outer edge of my right eye that was stage 0 melanoma.
She wasn’t too concerned but I have a follow up in 6 months… should I be more worried? I have been over exposed to the sun for years (life guarding, sports etc) and am 39. I also requested that she get my file from the last dr to see if there was anything in my file that could show history.
She said I have definite sun damage in both eyes… thank you!
Went to the eye Dr have a small dot in the back of my eye. Looks like a frakle. Should I be worried
Author
Hi Amy,
Freckles in the back of the eye are fairly common. Typically, the largest concern about them is due to the fact that you cannot self monitor them for changes like you can on your skin. There is a very low transformation to melanomas over time, similar to freckles on your skin. As long as the freckle is not atypical, your eye doctor will probably want to re-examine your eyes every year or two to make sure nothing has changed.
Best Wishes!
Author
Hi Steph,
I am not sure what they meant. Perhaps it was in reference to the appearance of the optic nerve head. Squiggly might refer to an undefined border on the nerve head. If that is the case it could be due to increased pressure around the brain, the presence of optic nerve head drusen, a malformed nerve, or other factors. Without knowing what they were referring to it is hard to say. Try and have them define what they mean a little better, it could help your peace of mind.
Best Wishes!
Author
Hi Carrie,
I routinely have people come back for a second look if I find a freckle they were unaware of inside their eye. That is just to check for any changes. I have never seen a normal appearing freckle look any different at 6 months. The only time you would need to be a little more concerned would be if the freckle was atypical in appearance to start with. If that were the case they probably would have wanted to do some more testing, like an OCT scan or other forms of imaging.
Best Wishes!