Spotted: ocular naevus in our eyes

Written by: Professor Bertil Damato
Edited by: Sarah Sherlock

Just as on the skin, there can appear freckles or spots that look like moles on our eyes. Similarly, some may be harmless and some may require medical professional attention. In this article, renowned and esteemed consultant ophthalmologist Professor Bertil Damato explains in detail what ocular naevus is and answers important questions.


ocular naevus


What is an ocular naevus?

Ocular naevus (i.e., ‘mole’) is a benign (i.e., non-cancerous) tumour (i.e., swelling) composed of melanocytes. These are cells that produce melanin pigment. Melanin absorbs light to protect surrounding tissues from damage caused by ultraviolet radiation.


Within the eye, most naevi develop in the choroid, a thin, cup-shaped tissue lying under the retina, at the back of the eye, and in the iris, the grey, brown, or blue tissue that adjusts the size of the pupil to regulate the amount of light reaching the retina. Naevi can also develop outside the eye, in the conjunctiva, which is a transparent membrane covering the white of the eye and the inner surface of the eyelids.



How common are ocular naevi (‘moles’)?

Choroidal naevi are found in about 6 per 100 individuals, more commonly in light-grey or blue eyes than in brown eyes. Conjunctival naevi are less common, especially in individuals with a dark complexion.



How are ocular naevi diagnosed?

Choroidal naevi are usually small and flat with a featureless, grey surface. In a small minority of patients, the lesion is larger than usual so that it is called ‘suspicious naevus’. To help optometrists and ophthalmologists distinguish benign naevi from malignant melanomas, Professor Damato has developed MOLES, an acronym which stands for mushroom shape, orange pigment, large size, enlargement, and subretinal fluid. Each of these features is given a score between 0 and 2. Tumours are diagnosed as common naevus, low-risk naevus, high-risk naevus, and probable melanoma according to whether the sum total of these five scores is 0, 1, 2 or more than 2. The recommended management is for patients with common naevi to be monitored by a community optometrist, with patients having a low-risk or high-risk naevus referred to an eye specialist for expert examination, with those having a probable melanoma referred urgently, to be seen by an eye specialist within two weeks.


Conjunctival naevi tend to be small, usually containing several visible clear cysts. The tumour colour varies from black to light grey or brown.



What problems can naevi cause?

Very rarely, choroidal naevi show malignant (cancerous) growth, when they are termed ‘melanoma’. All naevi should therefore be documented, by photography if possible, and reviewed every two years, or more frequently if any suspicious features are present (i.e., MOLES score >0, see above). Conjunctival naevi can also show malignant growth, albeit rarely. Some patients consider their conjunctival naevus to be a cosmetic problem.



How are ocular naevi treated?

Choroidal naevi are not usually treated unless the risk of malignancy is high, in which case they are managed in the same way as small melanomas. In some cases, it is possible to establish the diagnosis by biopsy.


Conjunctival naevi can be removed if there are concerns about malignancy or if they cause cosmetic deficit. Surgical excision is performed under local anaesthesia, with sedation.



If you have recently noticed a spot on your eye or someone's you know, you can get it checked and schedule a consultation at Professor Damato's profile.

By Professor Bertil Damato

Professor Bertil Damato is an internationally-esteemed consultant ophthalmologist based in central London. He provides expert, industry-leading treatment in adult ocular oncology (eye tumours) including ocular naeviocular melanoma and ocular carcinoma alongside ocular metastasis and conjunctival melanosis. He practices privately at the London Claremont Clinic and Moorfields Private Eye Hospital in central London. He is an NHS consultant ophthalmologist at Moorfields Eye Hospital NHS Foundation Trust and Senior Clinical Research Fellow at the Nuffield Laboratory of Ophthalmology, University of Oxford.  
Professor Damato is responsible for various innovations in modern ophthalmology. Among others, he most recently developed 'MOLES'. This is a simple algorithm that distinguishes benign naevi (moles) from malignant melanomas at the back of the eye. Other progressive developments he has been at the forefront of, like proton beam radiotherapy of iris melanoma and survival prognostication in uveal melanoma are now widely practised. 

Professor Damato is a highly-decorated professional with various awards and official recognition from the NHS and ophthalmology organisations around the world. As well as exercising his impressive specialist knowledge in his practice, he also has expertise in counselling and supporting patients with eye cancer, having written a thesis on the subject.

Professor Damato received his undergraduate education at the University of Malta's School of Medicine, his postgraduate training in Glasgow, specialising in ophthalmology and ocular oncology, and completed his PhD in 1987.

In 1993, he founded the ocular oncology service at Royal Liverpool University Hospital, which has become internationally recognised as a centre of excellence. In 2013, he was invited to lead the ocular oncology service at the University of California San Francisco hospital as Professor of Ophthalmology and Radiation Oncology. 

Upon returning to the UK in 2018, Professor Damato was appointed Senior Clinical Research Fellow at the Nuffield Laboratory of Ophthalmology, University of Oxford, founding the ocular oncology service at Oxford Eye Hospital. He also joined the ocular oncology team at Moorfields Eye Hospital at that time. 

For many years, Professor Damato has lectured extensively around the world (virtually at present), usually as an invited speaker. He is an active member of various medical associations including the Royal College of Ophthalmologists, the Academia Ophthalmologica Internationalis, the International Society of Ocular Oncology and the European Ophthalmic Oncology Group. He has served as president of the latter two as well as the European Vision and Eye Research Association. Furthermore, he is an honorary fellow of the Ophthalmological Society of Alberta, Canada, and the College of Optometrists, UK.

He has published more than 300 articles in scientific journals, 100 textbook chapters, and had authored/co-authored or edited several ocular oncology textbooks. Professor Damato has received numerous awards, including the Bjerrum Medal (Denmark), Cohen Medal (South Africa), Shields Award (Hong Kong), Watson Medal (UK), Ashton Medal (UK), Rhett Buckler Award (USA), Secretariat Award, American Academy of Ophthalmology (USA), and others. 

Revered by colleagues and members alike, Professor Damato celebrates his impressive career achievements at Liverpool Oncology Centre with the Liverpool Ocular Oncology Research Group (LOORG).

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