What it Means to Have a Freckle in the Eye

You've just completed your annual eye exam and your doctor says you passed with flying colors. However, while examining the inside of your eyes, he discovered a small choroidal nevus. Although the name sounds complicated, a choroidal nevus is simply a freckle inside the eye.

A choroidal nevus is the name given to a spot, freckle or mole that appears inside the eye or on the eye's surface. Sometimes detected during a dilated eye examination, these pigmented spots are usually flat and slate-greyish in color. Choroidal nevi are commonly found in the choroid, a blood vessel-rich layer lying between the retina and the sclera. Although they are not necessarily a "normal" finding in our eyes, they are quite common and may not represent anything wrong with the eye. Nevi vary from patient to patient but most look very similar and have certain traits that eye doctors are very familiar with. Your doctor will document this finding in your chart if it is detected during a routine eye exam.

Most choroidal nevi do not cause symptoms. Most nevi are discovered during a routine eye examination. If nevi grow and disrupt the surrounding tissue, they may cause fluid or blood to leak out of the tissue. If this occurs, it can cause a retinal tear or detachment. Often, people with a retinal tear or detachment will complain of seeing flashes of light or new floaters in their visual field.

Choroidal nevi are fairly uncommon. Many of us have retinal pigmentation variations that are more common but true choroidal nevi are fairly uncommon, especially large nevi. The best recommendation is to have annual eye examinations which include dilating the eyes with special eye drops. If you have a nevus, then your doctor may want to see you every 3-6 months for the first year or two when first identified. He or she will want to keep a close eye on possible changes.

Choroidal nevi are not usually harmful. However, just like a freckle on your skin, if it changes in color, size or shape, you should let your doctor or a dermatologist know about it. It is difficult to observe a freckle in your own eye. You should follow your eye doctor’s recommendations on when to come back or how to observe it in the future.

Typical treatment involves taking a digital photograph for documentation. Your doctor will then schedule you to come back in 3 to 6 months to look for possible changes. If your doctor has seen you for several years, then he or she may feel comfortable monitoring the nevus every 12 months. If it appears unusual, however, you may be asked to return in a shorter period of time. Occasionally, certain diagnostic tests may be ordered, or you may be referred to a retinal specialist for a second opinion.

Choroidal nevi are benign, however, your eye doctor is trained to watch closely for the development of a choroidal melanoma, a tumor found in the eye. In rare cases, the nevus must be biopsied and examined for melanoma (cancer) cells. Choroidal melanomas are malignant tumors and must be treated. They may spread (metastasize) to other parts of your body and can be fatal. 

If you are diagnosed with a choroidal nevus, ask your doctor to give you a picture of it. Date the picture and keep safe with your medical files. If you ever change eye doctors or have a need to see an eye specialist, it will come in very handy. A documented picture will save your eye doctor time by providing evidence that your condition has been detected previously, has not grown and is, most importantly, benign.