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Red Green Color Blindness
Red green color blindness is the most common type of color blindness. As the name suggests, it means that a person is unable to tell the difference between green and red. This condition is usually genetic and sex linked. It affects males much more commonly than women. In fact, about 8% of men are color blind.In addition to not being able to make out a different between the red and green colors, patients may also experience variation in how bright colors are. The shades of different colors may also be difficult to distinguish for patients with red green color blindness. Red green color blindness is not something that develops over time. It is present from birth. Because of this, patients may not experience symptoms in the classic way because they are use to the way that they see the world. They do not really know anything different. Many times patients do not know they have this color blindness until it is brought to their attention from a friend, family member or medical professional. In extremely rare cases, color blindness could develop from a brain injury or stroke, but this is a small minority of cases. There are cases of color blindness that may be associated with other eye problems. One of these is diseases is called Achromotopsia. In this disease, children have poor vision and also have very rapid eye movements. The medical term for these involuntary eye movements is called nystagmus. Within red green color blindness, there are different types. The most common type of red green color blindness is Deuteranomaly. In this sub category, green colors appear more red. It is generally a mild type of red green color blindness. The opposite of this is Protanomaly in which red colors appear more green. This is also generally a mild form of color blindness. In the more severe forms of red green color blindness known as protanopia and deuteranopia, a patient is completely unable to tell the difference between red and green.There are simple tests online and in your doctor’s office that can determine if you have red green color blindness. One of the most common is called the Ishihara color plates test. These tests involve looking at a number or a pattern that is hidden inside a circular image. People who are color blind will not be able to figure out what the number is. There is no treatment and there is no cure for red green color blindness. There are certain digital applications that can help patients identify colors. These are easily available to download on your digital device. Most patients with color blindness function very highly and it does not interfere with their daily life. Sources:Simunovic MP. Acquired color vision deficiency. Surv Ophthalmol. 2016 Mar-Apr;61(2):132-55. doi: 10.1016/j.survophthal.2015.11.004. Epub 2015 Nov 30. PMID: 26656928.https://pubmed.ncbi.nlm.nih.gov/26656928/El Moussawi Z, Boueiri M, Al-Haddad C. Gene therapy in color vision deficiency: a review. Int Ophthalmol. 2021 May;41(5):1917-1927. doi: 10.1007/s10792-021-01717-0. Epub 2021 Feb 2. PMID: 33528822.https://pubmed.ncbi.nlm.nih.gov/33528822/https://aapos.org/glossary/achromatopsia
3 min read
One Pupil Bigger Than Other?
When you look in the mirror, are your pupils different sizes? The scientific name for having one pupil bigger than the other is called anisocoria. The word anisocoria means that that the pupils are not the same size. There are different types of anisocoria and it is important to understand the difference between them. Because having different size pupils can be a sign of something dangerous in the brain or body, it is always a good idea to see an ophthalmologist if you notice anything abnormal. Physiologic anisocoria, also called simple anisocoria, means that the pupil is a different size because that is just the way your body is. It is not a sign of something else harmful going on in the body. Even though physiologic anisocoria is usually present for years, people may notice it suddenly and become concerned. Many people have physiologic anisocoria. It is estimated that 1 in 5 people, or 20% of the population has simple anisocoria with a difference in pupil size of less than or equal to 1 mm. Both pupils react to light normally. Interestingly, physiologic anisocoria can be intermittent, which means it is not present all the time. In some cases, it can even completely resolve on its own. An ophthalmologist can diagnose anisocoria during an in person eye exam. The eye doctor will test your pupils in light and in the dark, and also take a close look at your pupils using a machine called a slit lamp. How your pupil reacts in both situations will help determine the cause of the anisocoria. In the light, if the bigger pupil does not constrict, then it is likely that that pupil is the problem pupil. In the dark, if the pupil stays small, when it is suppose to dilate, then it is likely that this pupil is the issue. The doctor may also ask to see an old photo of you or ask to see your photo ID. This is because they want to see if they can notice a difference in your pupil size from years earlier. If you have always had a difference in pupil size then it is more likely that this is not an emergent situation. However, if the difference in your pupil size is new, or if it is accompanied by other symptoms, it may be something they need to send you to the emergency room for. Some concerning signs and symptoms with anisocoria are also having double vision, eyelid ptosis (droopy eyelid) or having abnormal eye movements. Aside from physiologic anisocoria, there are disease in the eye, body and brain that can cause a difference in pupil size. Some of these include Horner’s syndrome, Adie’s Tonic Pupil, stroke, intracranial hemorrhage, and a brain tumor. Sometimes patients may also have anisocoria from eyedrops or medications. This is called pharmacologic anisocoria. If you notice that one pupil is bigger than the other, you should seek medical attention right away. While physiologic anisocoria is not harmful and happens to 20% of people, there are dangerous causes of anisocoria that need to be ruled out by a medical professional. It may be helpful for you to show your doctor old picture of yourself to see if the anisocoria was present at the time you took the photo. Be sure to also tell your doctor about any other symptoms you might be having and if you are taking any medications. Sources:Gross JR, McClelland CM, Lee MS. An approach to anisocoria. Curr Opin Ophthalmol. 2016 Nov;27(6):486-492. doi: 10.1097/ICU.0000000000000316. PMID: 27585208.https://pubmed.ncbi.nlm.nih.gov/27585208/Falardeau J. Anisocoria. Int Ophthalmol Clin. 2019 Summer;59(3):125-139. doi: 10.1097/IIO.0000000000000276. PMID: 31233420.https://pubmed.ncbi.nlm.nih.gov/31233420/Steck RP, Kong M, McCray KL, Quan V, Davey PG. Physiologic anisocoria under various lighting conditions. Clin Ophthalmol. 2018 Jan 4;12:85-89. doi: 10.2147/OPTH.S147019. PMID: 29379269; PMCID: PMC5757963.https://pubmed.ncbi.nlm.nih.gov/29379269/
4 min read
Cranial Nerve 2 : The Optic Nerve
The optic nerve is the second cranial nerve, which is also written at CN II or cranial nerve II. It connects the brain to the human eye. During an eye exam, an ophthalmologist can use a special lens to view the optic nerve's entry into the eye. The optic nerve is considered to be part of your nervous system. The function of the optic nerve is to carry visual information that it receives from the eye to the brain. This allows your brain to form images. There are many different types of visual information that the optic nerve is responsible for transmitting to the brain. This includes brightness perception, color vision, visual acuity or visual accuracy, and the ability to discern contrast or contrast sensitivity. Therefore, if someone has damage to their optic nerve, they will also have difficulties with their vision. Depending on the type of damage, the vision loss from optic nerve damage can be related to peripheral vision, central vision, color vision, contrast sensitivity, or complete vision loss.The optic nerve is also responsible for how your pupil reacts in light and dark and also when you are trying to read fine print. In bright lights, the optic nerve receives a signal that it sends to the brain telling the pupil to constrict or get smaller. When you are reading fine print, the pupil and lens of the eye change to help you read, and this process is called accommodation. These two neurological reflexes are called the light reflex and the accommodation reflex. Certain disease states such as syphilis may affect one of these reflexes but not both.The blind spot in the eye is real. This means there is an area of your visual field that you can not see because there are no photoreceptors there. The blind spot in the eye is caused by the entry of the optic nerve into the eyeball. Damage to the optic nerve and optic nerve function can be determined by several tests which an eye doctor can do in their office. Examining the optic nerve may reveal that one nerve is different in color than the other. Ophthalmologists refer to this as optic nerve pallor. Optic nerve pallor may need testing beyond what a general eye doctor can do and you may need to be referred to a Neuro Ophthalmologist.There are a few different ways to test for optic nerve function. The first is a pupillary exam. An eye doctor will evaluate one pupil first and then the second pupil. They will then also perform a swinging flashlight test where they quickly move the light from side to side to see how the pupils react. Another test is a visual field test which helps to assess if any parts of your visual field have been compromised. Another optic nerve function test is a color vision test. In patients who have optic nerve damage, their color vision may also be compromised. Finally, an OCT or optical coherence tomography test can test the retinal nerve fiber layer and see if there is any thinning of the optic nerve. Cranial nerve II is also called the optic nerve and it is responsible for carrying visual information from the eyeball to the brain. Damage to the optic nerve will likely cause visual problems. Sources:Selhorst JB, Chen Y. The optic nerve. Semin Neurol. 2009 Feb;29(1):29-35. doi: 10.1055/s-0028-1124020. Epub 2009 Feb 12. PMID: 19214930.https://pubmed.ncbi.nlm.nih.gov/19214930/Miller NR. The optic nerve. Curr Opin Neurol. 1996 Feb;9(1):5-15. doi: 10.1097/00019052-199602000-00003. PMID: 8722657.https://pubmed.ncbi.nlm.nih.gov/8722657/
4 min read
Blurry Vision In One Eye
Having blurry vision in one eye can be a scary thing to experience. What are some of the reasons you might have blurry vision in one eye only? If you have blurry vision in one eye that also is painful, it could be a corneal abrasion. A corneal abrasion is a scratch on the surface of the eye. It can be very very painful. It can happen after something has hit the eye or if you have a contact lens that could have scratched the eye. If you think you have a corneal abrasion you should try to see an ophthalmologist within 24 hours. Another cause of blurry vision in one eye that is also painful, is angle closure glaucoma. This is not quite as common as a corneal abrasion but it could happen. In this situation you may also have a headache or even nausea and vomiting. This is a medical emergency and you need to seek care from an ophthalmologist or emergency room immediately. The longer you wait to see a doctor if you have angle closure glaucoma, the more harmful it can be. Angle closure glaucoma is different from open angle glaucoma which is usually a slow, painless loss of vision.One of the most common causes of blurry vision in one eye is dry eyes. Other symptoms of dry eyes include a gritty sensation inside the eye, or feeling like something may be stuck inside the eye. Dry eyes can also tear, so watch out for this symptom also. You can use some over the counter artificial tears to see if this helps to clear up the blurry vision. If you have blurry vision in one eye that is painless it could be a sign of a problem in the back of the eye. Some problems in the back of the eye include retinal tears, retinal detachments, or a vitreous hemorrhage (a bleed in the back of the eye). The only way to evaluate this is to have a full dilated eye exam with an ophthalmologist. If the blurry vision came on suddenly, you should seek medical care as soon as possible. If you have a retinal detachment, seeing a retina specialist who can evaluate you for surgery is important.Ocular migraines can also cause blurry vision in one eye that is painless. Sometimes ocular migraines are also associated with a headache but it is not always the case. In an ocular migraine the area of blurry vision may also be associated with colors or even the feeling of looking through a kaleidoscope. Ocular migraines tend to resolve on their own but they can happen again. In most cases ocular migraines do not cause long term visual damage. You should still have a full dilated eye exam to ensure that there is no other cause of your eye symptoms. Cataracts can also cause painless blurry vision in one eye, but this change is usually gradual. Cataracts are normal part of aging and eventually need to be removed from the eye with surgery. A change in your eyeglasses prescription can also cause blurry vision in one eye. This is also typically a gradual change that occurs with time. If you experience a sudden change in vision, this is less likely to be from the development of cataracts or a change in your prescription.Experience blurry vision in one eye is not normal, especially if it comes on suddenly. There are many different causes, and sometimes there can be pain associated with the blurry vision. If you experience blurry vision in one eye that happens all of a sudden, you should seek medical care from an eye doctor as soon as possible.
4 min read
Diabetes In Eye: Who Is At Risk?
Diabetic retinopathy is the medical terminology for diabetes eye problems. It is one of the leading causes of irreversible blindness in the world. Diabetic eye disease can happen from Type 1 or Type 2 diabetes, but the risk with Type 1 is much higher. This is because Type 1 Diabetes tends to happen earlier in life and a person has to live with it for many years. A study was done to evaluate the rates of diabetic retinopathy. This study was The Wisconsin Epidemiologic Study of Diabetic Retinopathy, abbreviated as WESDR. This study showed that after having diabetes for 20 years, 99% of patients with type 1 diabetes will some level of diabetic retinopathy. Type 2 diabetics are also likely to develop diabetic retinopathy, but are less likely than people who have Type 1 Diabetes. The WESDR study showed that after 20 years, 60% of type 2 diabetics will have some degree of diabetic retinopathy in the eye.If you developed diabetes during your pregnancy (called Gestational Diabetes Mellitus, or GDM), you have a 70% chance of going on to develop Type 2 diabetes in your life. If you already have diabetes and become pregnant, your diabetes could become much worse during pregnancy so it is important to control your blood sugars so that you do not have pregnancy-related complications or any eye problems from diabetes.There are a few risk factors for developing diabetic eye disease. The first major risk factor is how long a patient has had diabetes. Since Diabetes Type 1 develops earlier in life, it is not surprising that nearly all patients with Type 1 Diabetes will have some degree of retinopathy after 20 years. Poor blood sugar control is another major risk factor for developing diabetes eye problems. Blood sugar control is measured in two ways. One is through a daily prick with an at-home glucose monitor. This gives you your blood sugar level at that moment. There is a blood test for Hemoglobin A1C which gives your doctor an average of how your blood sugar has been doing over the last 3 months. This level is important because it is not just about one point in time but rather has 3 months of data. High hemoglobin A1c (HbA1c) levels increase your risk of diabetic eye disease. Also, high blood pressure is associated with an increased risk of diabetic retinopathy. There is more than one way diabetes can affect the eye. In some patients, diabetes can cause swelling in the central part of the retina. This is called macular edema. In other cases, patients may have bleeding in their retina, or can even develop a retinal detachment from their diabetes. Some patients with diabetic eye problems will have new vessels that grow in different parts of their eyes. While new blood vessels do not seem like a bad thing, having new blood vessels grow inside the eye is very dangerous. These vessels can disrupt the way the normal eye works and cause bleeding, increased pressure, and vision loss. In most cases, early diabetic eye diseases are not very symptomatic. In fact, most patients have no idea that their eye is being negatively affected by diabetes until they go to see an eye doctor. It is important to see an ophthalmologist at least once a year for a dilated eye exam if you have diabetes. If you have poorly controlled diabetes, then your ophthalmologist may even want to see you every 6 months. One late symptom of diabetic eye disease is blurry vision, which may be from macular edema but also could be from bleeding in the eye (vitreous hemorrhage). Another symptom can be total vision loss or severe blurry vision. This may be from a retinal detachment. In less common cases, eye pain and eye redness can be a result of diabetes if the diabetes is causing a high eye pressure. This is called neovascular glaucoma and it is a very serious and late-stage complication of diabetes. Good blood sugar control is the number one factor in preventing diabetic eye problems. Once diabetic retinopathy develops it causes many other problems in the eye like retinal detachments, bleeding, and even glaucoma. It is very important to control your blood sugar and to see an ophthalmologist for a dilated eye exam every year if you have diabetes. Once you lose vision from diabetes, it is very hard, even with modern treatment, to recover all of the lost vision.Sources:Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82. doi: 10.1016/S0161-6420(03)00475-5. PMID: 13129861.https://pubmed.ncbi.nlm.nih.gov/13129861/Sabanayagam C, Banu R, Chee ML, Lee R, Wang YX, Tan G, Jonas JB, Lamoureux EL, Cheng CY, Klein BEK, Mitchell P, Klein R, Cheung CMG, Wong TY. Incidence and progression of diabetic retinopathy: a systematic review. Lancet Diabetes Endocrinol. 2019 Feb;7(2):140-149. doi: 10.1016/S2213-8587(18)30128-1. Epub 2018 Jul 11. PMID: 30005958.https://pubmed.ncbi.nlm.nih.gov/30005958/Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010 Jul 10;376(9735):124-36. doi: 10.1016/S0140-6736(09)62124-3. Epub 2010 Jun 26. PMID: 20580421.https://pubmed.ncbi.nlm.nih.gov/20580421/
5 min read
Optometry Vs Ophthalmologist
With the names of Ophthalmologist, Optometrist, and Optician, it can be difficult to know which person to visit and who is the best person to manage your eye problems. The basic difference is an Ophthalmologist is a medical doctor (degree of MD or DO) who goes to medical school, and an optometrist practices in the field of optometry, but does not go to medical school and does not complete a surgical residency. An optician is not an eye doctor. In many offices, ophthalmologists, optometrists and opticians will work together.An ophthalmologist is a fully licensed medical doctor (MD or DO) who has completed extensive education and comprehensive training to treat all eye conditions. They are trained surgeons and are licensed to prescribe medications in the treatment of eye diseases. An Ophthalmologist is different from an optometrist given their increased training and a broader scope of practice. Ophthalmologists are able to perform comprehensive eye exams, provide a variety of vision tests, provide a diagnosis, and treat all eye conditions with medication or perform surgery if needed. They are also able to prescribe glasses, and contacts to treat vision problems. Ophthalmologists are the eye professionals who are specially trained to manage all eye conditions, simple or complex, that other eye care professionals cannot treat. To become an ophthalmologist, one must receive an undergraduate degree before matriculating to medical school. After completing medical school for 4 years and earning an MD or DO degree, these doctors must undergo further specialty training and apply for a competitive spot in Ophthalmology residency. Ophthalmologists then complete ophthalmology residency for 4 years, during which they practice surgery and prescribe medications for all types of eye diseases. After completing residency, an ophthalmologist can then decide to complete further subspecialty training by applying and competing for a position in a fellowship program for 1 or 2 years. Some of the most common subspecialty areas in Ophthalmology are Glaucoma, Cornea, Uveitis and Immunology, Ophthalmic Plastic and Reconstructive Surgery, Retina, Neuro-ophthalmology, Pediatric ophthalmology and Strabismus, Pathology, and Ocular Oncology. A fellowship-trained Ophthalmologist will have completed 9 or 10 years of education after college. Optometrists practice optometry and have a Doctor of Optometry (OD) degree. This is different from an MD or a DO, which are both degrees that an ophthalmologist can have, and they mean that the ophthalmologist has both medical and surgical training in ophthalmology. An optometrist is not a medical doctor. They do not go to medical school and do not complete surgical residency training as an Ophthalmologist does. An optometrist is able to do comprehensive eye exams, vision tests, and can prescribe glasses and contacts. Optometrists are able to diagnose certain eye conditions and prescribe medications for the basic treatment of some eye conditions like dry eye, glaucoma, and iritis. They are not surgically trained to do lasers or other complex procedures or surgery on the eye. An optometrist will usually refer to an ophthalmologist for lasers, procedures, and surgery. Optometrists may also refer to ophthalmologists in the case of more complex disease such as glaucoma, cataracts, and diabetic eye disease.Education: To become an optometrist, one must complete either 2-4 years of undergraduate education before attending optometry school. By attending and completing optometry school for 4 years, an individual will obtain a Doctor of Optometry (OD) degree. Optometrists can then choose to undergo optional specialty training for one year. The categories of optometric specialty training are primary care optometry, pediatric optometry, cornea and contact lenses, vision rehabilitation, and ocular disease. An optometrist will have completed 4 or 5 years of education after college. An optician is not an eye doctor. An optician is a technician who provides care to patients by helping to fit patients with glasses or contacts. They do not provide comprehensive eye exams, diagnose, or treat any medical conditions. Opticians will take measurements of the patient’s pupillary distance, vertex size, eye size, and temple length and use the glasses or contacts prescription written by Optometrists or Ophthalmologists to find the correct fit of glasses or contacts for a patient.When starting training to become an optician, most applicants have a high school degree or GED; however, this is usually not a requirement across the nation. Individuals may then obtain qualifications via three routes. The first route is by earning an optician certificate through a post-secondary school program which usually lasts one year. The second route is by attending a two year program in a college accredited by the commision on Opticianry Accreditation. This will award the individual an Associate’s Degree in Ophthalmic Dispensing. The third route is by obtaining an apprenticeship under the supervision of an Ophthalmologist or Optometrist. Although there are a certain number of hours required for satisfactory completion of an apprenticeship, the requirements vary across the nation. The eyes are the organs responsible for vision and arguably the most important sense, sight. Unfortunately, there is no replacement for the eye. Therefore, staying up to date with eye health and visiting an eye doctor at regular intervals is important. Each eye care professional has a different level of training, expertise, and a different scope of practice (what each person can and can not do) which gives them the ability and knowledge to treat a specific eye problem. An ophthalmologist is a general eye doctor and an eye surgeon who can do lasers, eye surgery, as well as basic eye exams for glasses and contacts. An optometrist is an eye care professional who usually does general eye exams but does not have surgical training or training to perform lasers. Depending on your needs, you can make the decision to see an optometrist or an ophthalmologist. An optician is not a doctor and is a professional that can help you get fitted for the right pair of glasses. An optician can not perform an eye exam.
6 min read
What Eye Color Is The Rarest?
Eye color is determined by the color of your iris. The iris is the tissue of the eye that makes a circle to form your pupil. The pupil gets bigger or smaller depending on the contraction of the iris. The color of the iris is what determines a person's eye color.The rarest eye color is actually not a color at all. The American Academy Of Ophthalmology conducted a survey in 2014 of eye colors and the findings are as below (1) :In the United States:If you don't count the last line, then the rarest eye color is green according the survey done by the AAO above. The most common eye color is brown. In the United States, almost half the population has brown eyes.Did you know that blue eyes are not actually blue? Blue eyes are blue because the tissue scatters light so more blue light reflects out. This is similar to how the sky is perceived as blue by the human eye. On the other hand, brown eyes are actually brown. Brown eyes are brown because of melanin which is a pigment. Melanin is the same pigment that makes some skin darker than others. For the other eye colors like green or hazel, the level of pigment is somewhere between brown eyes and blue eyes. There are some parts of the iris that have no melanin like blue eyes and some that do have pigment like brown eyes. The interaction between the blue light and the brown pigment makes the eye look green, hazel, or even speckled. The best way to "change" your eye color is to use colored contact lenses. Even if you don't have the need for a prescription to see clearly there are colored contacts available without a prescription. If you haven't worn contacts before you will need to go in to see an eye doctor who can help fit you for your first pair and also teach you how to take your contacts in and out of your eye. Iris impants have been done in some countries to change a person's eye color but they are often associated with inflammation and can cause may eye issues. Due to the potential for vision threatening eye problems, ophthalmologists in the United States generally advise against iris implants. Currently, there are no FDA approved iris implants for the purpose of changing your eye color. The rarest eye color is green and the most common eye color is brown. Brown eyes are brown because of the pigment melanin. If you don't like your eye color, you can change it by using colored contact lenses. Colored contacts are available for people even if they don't need a prescription for glasses to see clearly. You should see an eye doctor to get initially fitted for contact lenses and for them to teach you how to put in and take out a contact lens from the eye. Sources:(1) https://www.aao.org/eye-health/tips-prevention/your-blue-eyes-arent-really-blue(2) https://my.clevelandclinic.org/health/articles/21576-eye-colors#:~:text=Brown%2C%20which%20is%20the%20most,combination%20of%20brown%20and%20green.
3 min read
Freckle In The Eye
A freckle in the eye is called a nevus in medical terminology. The word nevus (the plural form of this is nevi) is a medical word that refers to a mole or freckle. It is an area of your body that is typically darker in color or more pigmented than the rest of the surrounding cells of the body. We most commonly see freckles or moles on our skin, but you can also get a freckle in the eye. A nevus is a benign lesion meaning it is not a cancer and it does not grow significantly or cause harm. Just how a freckle on your skin can happen in many different places, a freckle in the eye can also happen in different parts of the eye including the iris, the conjunctiva (the white part of your eye), the choroid, and the retina. The choroid and retina are tissues in the back of the eye that only an eye doctor can see during a dilated eye exam. In the vast majority of cases, a nevus, or freckle in the eye, is not dangerous. It is important that they are monitored for change in size or other characteristics with regular dilated eye exams.Nevi in the eye are most common in the choroid which is in the back of the eye, close to the retina. A nevus is formed by a collection of cells (called melanocytes) which produce a substance called melanin that gives color or pigment to the skin. These nevi are called choroidal nevi and can only be viewed by an eye doctor during a dilated eye exam. In the choroid a nevus can be different colors including brown, gray and yellow and may have a speckle appearance. As with all nevi, they are typically benign but should be monitored to ensure there is no significant change in size or other characteristics. Nevi are often monitored by an eye doctor using regular eye exams and photographs of the retina to watch for signs of possible progression to a choroidal melanoma, although this is uncommon. A choroidal melanoma is a malignant or cancerous lesion which needs treatment to prevent it from spreading. Signs which may be concerning for progression to a melanoma include a lesion that is raised or elevated, associated with fluid or swelling, or orange in color.It is common to have pigmented, or darker colored, areas on the colored part of the eye, also known as the iris. Pigmented areas of the iris are more noticeable in people with light colored eyes like blue or green. They are seen as brown areas on an otherwise light colored eye. Small pigmented areas on the iris are likely freckles which are caused by a collection of melanin (a brown colored pigmented) in that area. These areas are benign with no risk of turning into a cancerous lesion. Larger pigmented areas are potentially iris nevi which are a collection of melanocytes causing the increase in pigment. Nevi are also benign with a small chance of turning into a iris melanoma and should be monitored by an eye doctor for changes in size or shape. An eye doctor will typically monitor a nevus with periodic photographes and/or measurements to ensure there are no significant changes.The conjunctiva is the clear covering or “skin” of the eye which covers the white part of the eye (called the sclera). The conjunctiva can also develop areas of pigment or nevi due to a collection of melanocytes within the conjunctiva. These typically appear as differing shades of brown but can sometimes be a lighter yellow color. Like nevi in other areas of the eye, these lesions are typically benign but should be monitored by an eye doctor with periodic examinations and/or photographs to ensure there are concerning signs for transformation into a cancerous lesion, or melanoma.Nevi are benign lesions and typically require only observation. Treatment is not recommended unless they transform to a more dangerous malignant lesion which is uncommon. If transformation to a melanoma does occur treatment may include surgery, laser, radiation or sometimes removal of the eye. The treatment recommended will depend on the size and location of the melanoma. SourcesShields CL, Shields JA, Kiratli H, et al. Risk factors for growth and metastasis of small choroidal melanocytic lesions. Ophthalmology 1995;102:1351–1361https://pubmed.ncbi.nlm.nih.gov/9097773/Shields CL, Furuta M, Berman EL, et al. Choroidal nevus transformation into melanoma: analysis of 2514 consecutive cases. Arch Ophthalmol 2009;127:981–987https://pubmed.ncbi.nlm.nih.gov/19667334/Kliman GH et al. Am J Ophthalmol. 1985;100(4):547-548
4 min read