A nevus in the eye is a common benign pigmented lesion often discovered during routine eye examinations. It is similar to a freckle or mole on the skin but located on the tissues within or around the eye. While most nevi are harmless and do not require treatment, questions frequently arise about whether surgery is necessary.
What Is an Ocular Nevus?
An ocular nevus is a flat or slightly elevated area of pigmentation caused by a localized accumulation of melanocytes, the pigment-producing cells. These nevi can occur on the conjunctiva, the clear membrane covering the white of the eye, or on the uveal tract, which includes the iris, ciliary body, and choroid.
Most ocular nevi are benign and stable over time. They are typically detected during comprehensive eye exams and appear as dark spots with well-defined borders. Unlike malignant melanoma, nevi do not usually invade surrounding tissues or spread to other parts of the body.
Does a Nevus in the Eye Need Surgery? When Surgery is Considered for Ocular Nevi
Surgical removal of an ocular nevus is not commonly required. Since most nevi remain stable and do not affect vision or eye health, a conservative approach with regular monitoring is the standard. Surgery is generally reserved for specific situations where there is concern for malignancy or when the lesion causes functional problems.
Signs that may prompt consideration of surgery include rapid growth of the nevus, changes in size or shape, irregular or indistinct borders, and associated symptoms such as visual disturbances or discomfort. These features raise suspicion for transformation into melanoma, a rare but serious ocular cancer.
Additionally, if the nevus affects vision by causing distortion, obstruction, or other complications, surgical intervention may be necessary to restore or preserve eyesight.
Risks and Benefits of Surgery
Surgery on the eye carries potential risks, including infection, bleeding, scarring, and damage to surrounding structures. Removal of a nevus located on the conjunctiva is generally less complex and has lower risk than procedures involving deeper tissues such as the choroid or ciliary body.
When surgery is indicated, the benefits include obtaining a definitive diagnosis through histopathological examination and preventing progression if malignancy is present. Early removal of suspicious lesions improves outcomes.
Patients should discuss the risks and advantages with their ophthalmologist to make an informed decision tailored to their specific condition.
Monitoring and Follow-Up
For most patients with an ocular nevus, routine observation with periodic eye examinations is sufficient. Eye care providers monitor the lesion using specialized imaging techniques such as photography, ultrasound, or optical coherence tomography to detect any changes over time.
Follow-up intervals depend on the nevus’s characteristics and risk factors. Stable nevi may be checked annually, whereas lesions with borderline features may require more frequent assessments.
Prompt reporting of any new symptoms such as blurred vision, flashes, or eye discomfort is crucial, as these may indicate changes requiring further evaluation.
Alternative Treatments
Aside from surgery, no widely accepted alternative treatments specifically target benign ocular nevi. Laser therapy or radiation is generally reserved for malignant tumors and is not used for typical benign nevi.
Patients should focus on regular monitoring and maintaining overall eye health. Protecting the eyes from ultraviolet radiation with sunglasses and avoiding trauma may help reduce risks to ocular tissues.
When to See an Eye Specialist
If a new pigmented lesion is noticed in the eye or if an existing nevus changes over time, consultation with an eye care professional is important. A specialist can perform a thorough examination, assess the risk of malignancy, and recommend appropriate management.
Early diagnosis of malignant transformation is critical, as ocular melanoma requires timely treatment to prevent vision loss and metastasis.