Conjunctival melanosis refers to brown or black spots that appear on the white part of the eye (sclera). Some people are born with these spots, while others develop them with age. In most cases, they are harmless, but in some instances, they may indicate underlying abnormalities requiring medical attention.
Conjunctival pigmentation can arise from various causes, which can be categorized into two main groups:
1. Benign Pigmentation
- Primary Acquired Melanosis (PAM) – Found in adults, appearing as scattered brown spots on the conjunctiva. These typically do not change significantly over time.
- Nevus (Eye Mole) – A well-defined brown lesion that may slightly enlarge with age.
- Genetic or Ethnic Pigmentation – More common in specific racial groups, such as Asians or Africans.
2. Potentially Harmful Pigmentation or Precancerous Lesions
- Primary Acquired Melanosis with Atypia (PAM with Atypia) – If PAM covers an area larger than 2 clock hours of the cornea, removal is recommended due to the risk of cancerous transformation. Close monitoring is essential.
- Conjunctival Melanoma – A rare but aggressive eye cancer that requires prompt diagnosis and treatment.
1. Safe pigmentation characteristics:
- Located on the superficial layer of the conjunctiva.
- Has remained the same size for over five years.
- Lacks abnormal blood vessels or rapid growth.
- Does not cause irritation or vision problems.
2.Pigmentation that requires medical evaluation:
- Rapid darkening or enlargement in a short period.
- Irregular borders, unusual shape, or multiple colors.
- Presence of abnormal new blood vessels.
- Spontaneous bleeding or eye irritation.
- High-Risk Locations for Conjunctival Pigmentation
*Medial Canthus (Inner Corner of the Eye): A common site for malignant transformation.
*Limbal Area (Border of Cornea and Sclera): Pigmentation extending onto the cornea requires careful observation.
*Palpebral Conjunctiva (Inner Eyelid): Less common but should be examined thoroughly if present.
If you notice pigmentation in these areas or any unusual characteristics, consult an ophthalmologist for further evaluation.
Pigmentation suitable for laser removal must meet the following criteria:
- Located in the superficial conjunctival layer.
- Stable in size for over five years.
- No abnormal blood vessels supplying it.
- No rapid changes in color or borders.
- Topical Anesthetic Drops: Ensures a painless experience.
- Precision Laser Treatment: Uses a high-accuracy LASIK machine.
- Post-Treatment Care: Eye patch for 1-2 nights.
- Recovery: Normal vision returns after the patch is removed, with mild redness that resolves within 1-2 weeks with prescribed eye drops.
- Risks of Improper Laser Treatment by Non-Specialists
- Uncontrolled bleeding.
- Large conjunctival epithelial defects.
- Severe scarring requiring surgical intervention.
- Chronic inflammation and pterygium formation.
Article by Dr. Sasi Yaisawang, Pioneer of Conjunctival Pigmentation Laser Treatment in Thailand 2024
If you have conjunctival pigmentation and wish to assess whether laser treatment is a suitable option, schedule an evaluation at
At Eye Clinic: 9/99 Ratchadaphisek 33 Alley, Lat Yao, Chatuchak, Bangkok 10900
Line: AtEye Clinic
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