Scleral Melanocytosis
Author:
Pavan Bang, MBBS
South Alabama Pediatrics, Opp, Alabama
Citation:
Bang P. Scleral melanocytosis. Consultant for Pediatricians. 2015;14(12):572.
A 7-year-old African American boy presented with bluish spots in both eyes that had been present since early childhood. All of the findings of a physical examination, including the boy’s vision, were normal. The grayish areas of pigmentation were determined to be scleral melanocytosis.
Scleral melanocytosis is a common pediatric condition that becomes prominent with increasing age and usually is bilateral. The benign condition is more common in persons of Asian descent.1
The condition characteristically features black or gray-blue pigmentation in the scleral tissue. Histologic examination shows dendritic melanocytes in the scleral and episcleral layers rather than in the conjunctival substantia propria.1 Thus, the conjunctivas can be moved over the hyperpigmented spots.
The differential diagnosis of scleral melanocytosis includes nevus of Ota, a benign melanosis that involves the periorbital skin, usually unilaterally, with the color ranging from various shades of brown to blue-black. Ocular melanosis frequently accompanies moderate or severe cases of nevus of Ota; it can range from patchy gray, blue, or black discoloration limited to the sclera (approximately two-thirds of cases) to hyperpigmentation of the entire uveal tract, conjunctiva, retina, and optic nerve.1,2 Nevus of Ota also is most common in persons of Asian descent, particularly the female Japanese population.1,2
References
- Leung AKC. A spot in the eye. Am Fam Physican. 1999;59(1):163-164.
- Disorders of pigmentation. In: Paller AS, Mancini AJ. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 4th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 11.