Pigmented conjunctival and scleral lesions

The multiple causes of pigmentations of the conjunctiva and sclera are reviewed, and the recommended therapeutic modalities are discussed.

Information from personal experience and the recent literature is summarized to determine the optimal diagnostic and treatment approaches for suspicious pigmented conjunctival and scleral lesions.

Clinical descriptions and illustrations are presented to characterize these ocular lesions.

Pigmented lesions of the conjunctiva and sclera arise from either melanocytes or nonmelanocytes and have a diverse differential diagnosis. These lesions can be classified into congenital melanosis, conjunctival nevi, acquired melanosis (secondary or primary), and conjunctival melanomas. In secondary acquired melanosis, the increased conjunctival pigmentation is caused by irradiation, hormonal changes, chemical irritation, or chronic inflammatory conjunctival disorders. The biologic behavior of primary acquired melanosis of the conjunctiva is a controversial topic with important implications because it may progress to melanoma. In patients with primary acquired melanosis, a biopsy is recommended in order to grade the disease, offer a prognosis, and direct further treatment. Conjunctival melanomas may arise from primary acquired melanosis, from nevi, or de novo, or they may be metastatic lesions.

Of the wide spectrum of melanocytic conjunctival lesions, those with malignant potential are melanosis oculi, nevus of Ota, junctional nevus, compound nevus, primary acquired melanosis, and melanomas.