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Ophthalmology – Conjunctival Nevus
Conjunctival nevus is the most common conjunctival tumor, accounting for a large proportion of melanocytic lesions of the ocular surface. It is typically a benign proliferation of melanocytes and may be present at birth (congenital) or develop during childhood or adolescence. Most lesions become clinically noticeable in the first or second decade of life and can change in pigmentation over time, particularly during periods of hormonal change such as puberty.
Clinically, conjunctival nevi appear as well-defined, slightly elevated lesions that may be pigmented (brown) or amelanotic (nonpigmented). A key distinguishing feature is the presence of intralesional cysts, which are often visible on slit-lamp examination and help differentiate nevi from malignant lesions. These lesions are most commonly located on the bulbar conjunctiva, especially near the nasal or temporal limbus in sun-exposed areas. Importantly, they usually do not extend onto the cornea and tend to move with the conjunctiva.
Most patients are asymptomatic and simply notice a “spot on the eye.” Occasionally, mild irritation or inflammation may occur. The condition is generally sporadic and rarely associated with systemic disease, although uncommon associations with syndromes like Carney complex have been reported.
Diagnosis is primarily clinical, supported by slit-lamp examination and photographic documentation. Anterior segment OCT can help identify cystic components within the lesion. Regular follow-up with serial photography every 6–12 months is recommended to monitor for changes in size, shape, or pigmentation.
Management is usually conservative. Observation is the standard approach for typical, stable lesions. However, surgical excision may be indicated if there are suspicious features such as documented growth, absence of cysts, prominent feeder vessels, unusual location (e.g., forniceal or tarsal conjunctiva), corneal involvement, or onset later in life. Excision is performed using a “no-touch” technique with cryotherapy to margins to reduce the risk of recurrence or malignant transformation.
The prognosis is excellent in the vast majority of cases, as conjunctival nevi are benign. Malignant transformation into melanoma is rare but possible, which is why periodic monitoring is essential. Complications are uncommon but may include mild irritation or dry eye following surgical removal.
Conjunctival nevus is the most common conjunctival tumor, accounting for a large proportion of melanocytic lesions of the ocular surface. It is typically a benign proliferation of melanocytes and may be present at birth (congenital) or develop during childhood or adolescence. Most lesions become clinically noticeable in the first or second decade of life and can change in pigmentation over time, particularly during periods of hormonal change such as puberty.
Clinically, conjunctival nevi appear as well-defined, slightly elevated lesions that may be pigmented (brown) or amelanotic (nonpigmented). A key distinguishing feature is the presence of intralesional cysts, which are often visible on slit-lamp examination and help differentiate nevi from malignant lesions. These lesions are most commonly located on the bulbar conjunctiva, especially near the nasal or temporal limbus in sun-exposed areas. Importantly, they usually do not extend onto the cornea and tend to move with the conjunctiva.
Most patients are asymptomatic and simply notice a “spot on the eye.” Occasionally, mild irritation or inflammation may occur. The condition is generally sporadic and rarely associated with systemic disease, although uncommon associations with syndromes like Carney complex have been reported.
Diagnosis is primarily clinical, supported by slit-lamp examination and photographic documentation. Anterior segment OCT can help identify cystic components within the lesion. Regular follow-up with serial photography every 6–12 months is recommended to monitor for changes in size, shape, or pigmentation.
Management is usually conservative. Observation is the standard approach for typical, stable lesions. However, surgical excision may be indicated if there are suspicious features such as documented growth, absence of cysts, prominent feeder vessels, unusual location (e.g., forniceal or tarsal conjunctiva), corneal involvement, or onset later in life. Excision is performed using a “no-touch” technique with cryotherapy to margins to reduce the risk of recurrence or malignant transformation.
The prognosis is excellent in the vast majority of cases, as conjunctival nevi are benign. Malignant transformation into melanoma is rare but possible, which is why periodic monitoring is essential. Complications are uncommon but may include mild irritation or dry eye following surgical removal.
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