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

1. Leung AKC. A spot in the eye. Am Fam Physican. 1999;59(1):163-164.
2. 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.