Dark Spots On Whites of Eyes

Dr. Kisling Eye Diseases, Uncategorized 42 Comments

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 (primary acquired 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 believe 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 is usually noted as Primary Acquired Melanosis and is localized in the conjunctival tissue layers.

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



Comments 42

  1. Phi Nguyen

    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. Post
    Author
    admin

    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

    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

    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. Post
    Author
    admin

    Hi Karina,

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

    Best Wishes

  6. julita

    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. Post
    Author
    admin

    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

    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. Post
    Author
    admin

    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

    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

    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

    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

    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. Post
    Author
    admin

    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. Post
    Author
    admin

    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

    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. Post
    Author
    admin

    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

    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. Post
    Author
    Dr. Kisling

    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

    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. Post
    Author
    Dr. Kisling

    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. Luka

    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.

  23. Post
    Author
  24. Post
    Author
    Dr. Kisling

    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!

  25. Lusina

    Hi dearest Dr. Kisling! First of thank you so much, You and your team do a great job, as your advices help people a lot!

    Well, my great concern is related to the eyes of my 4 year old kid. He has dark spots and lines in his sclera from his birth, they look like the picture you have posted here, but the blacks are present only in the white scleral part of the eyes. We’ve seen an eye doctor who said it can be nevus, another doctor said it’s not harmful stabile melanoma, which needs to be examined all the time… Sorry for writing long, but as a mother I am very much worrying. Currently his vision is 100%, but what if it changes, do you think we sould take some pills, or Calcium, or Vit. D? And what about Sun, can it increase the cynthesis of melanin, so the darks get wors? Thank you in advance, I appreciate it
    Looking forward to hearing from you as soon as possible!
    Regards
    Lusina

  26. Post
    Author
    Dr. Kisling

    Hi Lusina,

    You might check but I am presuming they did not mean melanoma but did mean melanosis. A melanoma is cancerous while ocular melanosis is not (but it does lead to a slightly higher incidence of melanoma. We all should avoid intense UV periods of the day but doubly so when ocular melanosis is present as it does have an effect in increasing the conversion to melanoma. Good sunglasses can go a long ways. A more recent treatment of melanosis that is progressing is Mitomycin C. If it seems to be getting worse over the years it would be worth investigating. Otherwise, as long as it seems stable he should be fine.

    Best Wishes!

  27. Ashish

    Hi, This is Ashish from India.
    I too have the same on both my eyes. I was hoping to see a treatment on this. Thanks for the lovely article Doc!

  28. Post
    Author
  29. Anna

    Hi,
    Thank you for all you answers!
    My 4 y old daughter has small grey spots in the sclera in both her eyes. The eye doctor said it might be ocular melanosis and she will have a yearly check up. I’ve understood there is an increased risk of ocular melanoma and glaucoma, but is there also an increased risk of melanomas in other parts of the body? Like the skin or central nervous system? I’m very worried about all this. My mother has been treated for uveal melanoma but does not have ocular melanosis as far as I know.
    Thank you
    Anna

  30. CeeCee

    Is it possible for people who are African or of African descent to have ocular melanosis? I am askign for research as I cannot seem to find the materials.

  31. Post
    Author
  32. Post
    Author
    Dr. Kisling

    Hi Anna,

    I do not believe there is an increased risk of melanoma elsewhere in the body unless there is already a melanoma in the eye. In that case it is more likely to spread elsewhere that a non ocular melanoma would be. Keep having those annual checkups for her.

    Best WIshes!

  33. Ashish

    Any more luck on this? Do you think the Seoul place would work. I dont mind going to Seoul and getting this done.

  34. Lee

    Hi Dr. Kisling,

    I was looking closely to my eyes a couple of days ago in preparation for a full body check with my dermatologist. I noticed that my left eye has a little bit of a somewhat yellow-tinged discoloration under the iris and also on the upper left corner.

    Also, as I was looking even closer, I noticed that there are two super tiny spots, I think even less that 1 mm that look somewhat grey (I can’t really tell if they’re grey or brown due to the size) at the end of a blood vessel and other two that stand alone. I honestly don’t know if I’ve always had them because I don’t normally check my sclera or my eyes for that matter. Also, both eyes show like a thin ring that looks blueish around them.

    I have a -5.75 prescription for myopia, I think that my optometrist told me that I have a thin retina as well, I suffer from floaters, but other than that all my annual eye exams have looked normal (dilation included); my last exam was on 02/14/15.

    What should I do? Would this be indicative of a malignant condition?

  35. Post
    Author
    Dr. Kisling

    Hi Lee,

    Find an old photo of yourself, grab a magnifier and you should be able to tell if this is a preexisting condition. I am willing to bet it has been like that for a long time.

    Best Wishes!

  36. Taylor Dt

    Thanks for the information. I wanted to write to let everyone out there know that there is a Facebook group for people with ocular melanosis (or parents with children tha have the condition) called M.O.M.S (Mothers for Ocular Melanosis Support). We have 53 members from around the world so far.

    Please join our group if you are affected by this condition or tell anyone with the condition about it.

    On a personal note, it’s hard to find an ophthalmologist with ocular melanosis experience– could you recommend someone in Minnesota (or the Midwest, for that matter)?

    Thank you!

  37. Post
    Author
  38. M. Khaliqi

    Hello doctor this me M khaliqi from afghanistan i come to know you thorugh a website and hereby i wluld like to share with you about my problem , i have blue mark in my sclera from my birth time at first when i was child i went to doctor Tom he told me that it caputured a big space in your eye but now it decreased alot even you can see a white place in my eye also now small white markes can be seen inside of it but i like to remove it completly so would u please inform me that what to do  and if there is any medecin to use i really dont want it please help me doctor,

    I am sending a photo of my eye as well but there was no attachment option please have contact with me ,looking forwerd to hera you as soon as possible.

    Sincerely

    M khaliqi

  39. Post
    Author
    Dr. Kisling

    Hi M. Khaliqi,

    Removal is generally not recommended. Sometimes it is removed surgically and/or with a Laser. There are no medicines that I am aware of to remove pigment. It sounds like it needs to be followed by an eye doctor.

    Best Wishes!

  40. janet

    Hi Dr. Kisling,

    You have a great website. thank you for taking the time to answer questions and offer support! Do you know of any correlation between estrogen and worsening of ocular melanosis? I read somewhere that taking birth control pills can make the pigment darker but haven’t been able to confirm. Thank you.

  41. Post
    Author
    Dr. Kisling

    HI Janet,

    That is a great question and I am kind of stumped. Estrogen inhibits the production of melanin so I presume with lower estrogen levels the appearance of ocular melanosis might get worse. However I don’t believe it would cause an increase in the number of melanocytes (the actual cells that produce melanin) so it probably would not actually make it worse. I can’t find any references on how this effects ocular melanosis so that is just my guess!

    Bets Wishes!

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