PIGMENTED CONJUNCTIVAL AND SCLERAL LESIONS

Objective: The multiple causes of pigmentations of the conjunctiva and sclera are reviewed, and the recommended therapeutic modalities are d iscussed. Design: Information from; personal experience and the recent literature is summarized to determine the optimal diagnostic and trea tment approaches for suspicious pigmented conjunctival and scleral les ions. Material and Methods: Clinical descriptions and illustrations ar e presented to characterize these ocular lesions. Results: Pigmented l esions of the conjunctiva and sclera arise from either melanocytes or nonmelanocytes and have a diverse differential diagnosis. These lesion s can be classified into congenital melanosis, conjunctival nevi, acqu ired melanosis (secondary or primary), and conjunctival melanomas. In secondary acquired melanosis, the increased conjunctival pigmentation is caused by irradiation, hormonal changes, chemical irritation, or ch ronic inflammatory conjunctival disorders. The biologic behavior of pr imary acquired melanosis of the conjunctiva is a controversial topic w ith important implications because it may progress to melanoma. In pat ients with primary acquired melanosis, a biopsy is recommended in orde r to grade the disease, offer a prognosis, and direct further treatmen t. Conjunctival melanomas may arise from primary acquired melanosis, f rom nevi, or de novo, or they may be metastatic lesions. Conclusion: O f the wide spectrum of melanocytic conjunctival lesions, those with ma lignant potential are melanosis oculi, nevus of Ota, junctional nevus, compound nevus, primary acquired melanosis, and melanomas.