26 yr male have grey spots since birth in sclera of both eyes noticed during routine examination in OPD. Kindly some ophthalmologist help to tell weather this scleral melanocytosis,nevi or thinning& if this is a benighn condition or need some education to person

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May be vit A deficiency. bitot's spot. advise oral vit A solution /cap. .

careful thorough examination is required .if no finding ,no treatmentis required immidiately.only under observation

Corneal pigmentation,normal.

appesr

The patient seems to have ocular melanosis, which is a slate grey pigmentation of the episclera. It is harmless. Important things to remember in a case like this: 1)Differentiate from Primary acquired melanosis of the conjunctiva (PAM). This type will move over the sclera on moving the conjunctiva and is dark brown in colour whereas ocular melanosis does not move with conjunctival movement (as it is at the level of the episclera), it is lighter slate grey in colour. PAM is not very common when compared to ocular melanosis and occurs after 45 years of age usually. It may increase in size over time and may be pre malignant. 2) There are 2 more types of melanosis which are dermal and oculodermal melanosis. In the former, Only the skin around the eye is pigmented and the eye is not involved. The latter is called Nevus of Ota where both the eye and skin around the eye are involved. 3) The skin pigmentation is usually in the area of innervation of the first and second divisions of trigeminal nerves. (very rare in the area of third division) 4) In nevus of ota, there will be also be associated hyper pigmentation of the iris, fundus and trabecular mesh work. There is also a possibility of glaucoma in these cases.

Thanks Dr Arun Rajan for your detailed answer.
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Benign conjunctival melanosis.needs periodic evaluation for melanoma

bitots spots. vit A deficiency. Give auasol A.

It's normal melanin pigmentation at exit point of episcleral arteries.

Ocular Melanosis Also known as Nevus of Ota Most patients with the Nevus of Ota have no subsequent related problems. So, no active treatment required. Less than 4% can develop choroidal melanoma in the affected eye. Fewer will develop intracranial neoplasia. Therefore, it is reasonable for all patients with the Nevus of Ota to have yearly eye examinations with dilated ophthalmoscopy. They should also have an initial neurology assessment, followed by annual medical evaluations.

Sir, Nevus of ota is oculodermal melanosis where the surrounding skin is also involved. This patient has ocular melanosis in which only the eye is involved.
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Ocular melanomas.need yearly examination

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