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Choroidal Nevi

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Q: At my last eye exam, my eye doctor mentioned that I had a “freckle” in my eye. He seemed not very concerned and ordered no other tests. Should I be concerned and what might be next?

A: This is not rare, but it is uncommon. We fairly often identify pigmented lesions or spots inside the human eye. I think it is common that we might refer to this as a “freckle” inside the eye. The term freckle just means some pigmented lesion or tissue, and this harmless-sounding term is used to prevent undue patient anxiety.

Understanding Choroidal Nevi

In reality, the majority of these pigmented lesions are benign and never develop into anything needing surgery or radiotherapy. In our clinic, when this pigmentation the retina is discovered we routinely order other tests. Experts recommend that the tissue be visualized with pupil dilation to facilitate a three-dimensional view of the area. Also indicated would be ocular ultrasound to provide imaging through and behind the eye. The basic idea to be sure that what we see in the retina is not the “tip of the iceberg”, meaning a tumor behind the eye. Lastly, we use chromatic filtering in retinal imaging to help localize the layer involved.

If these tests still indicate a benign pigmented lesion, we call that a choroidal nevus. The choroid is the layer of the retina involved, and nevus just means it is pigmented. If this is the first discovery of the pigmented tissue, a return evaluation in three to six months is prudent. Our goal is to establish that this lesion is not changing or growing.


For the small percentage of these that are progressive or malignant, treatment is primarily to devitalize the tissue with radiotherapy. The ultimate goal is to prevent any spread or metastasis of any cancerous tissue outside the eye to other parts of the body.

Unfortunately, malignant lesions can develop at any age. We routinely recommend full interior retinal imaging for all age patients…..even children! It is more difficult to thoroughly examine the retina of a young child, so new non-dilated imaging can show us the whole retina far more easily as a screening tool. For you, and really all people, retinal imaging is an excellent diagnostic procedure to find diseases such as this……long before any symptoms appear or before any vision is lost. Too often, people mistakenly think that a change in vision just means time for new glasses….when far more serious issues may be to blame.

Call Morgantown Eye Associates on 304-381-5353 to schedule an eye exam with our Morgantown optometrist.

Alternatively book an appointment online here CLICK FOR AN APPOINTMENT


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