An eye lesion is any abnormal change, growth, or area of damage affecting the eye and its surrounding tissues. These changes can occur on the eyelid, the clear outer dome of the cornea, the white of the eye (sclera), or the lining of the eye (conjunctiva). Lesions vary widely, ranging from minor, temporary irritations to indicators of serious underlying disease or malignancy. Assessing the location and appearance of a lesion helps determine its potential severity and the appropriate course of action.
Defining Eye Lesions by Location and Appearance
Eye lesions are classified by the specific anatomical structure they affect, which helps narrow down the possible diagnoses. Eyelid lesions frequently involve the sebaceous or sweat glands. A stye (hordeolum) is a painful, red, and swollen bump near the eyelash line caused by a localized bacterial infection. A chalazion is a less painful, firm lump resulting from a blocked oil gland duct, often lacking the acute inflammation of a stye. While some growths, like seborrheic keratosis, are benign surface growths, a basal cell carcinoma may present as a translucent, flesh-colored nodule. Loss of eyelashes associated with a nodule is a sign of potential malignancy.
Lesions of the conjunctiva, the transparent membrane covering the inner eyelid and the white part of the eye, typically manifest as colored or raised patches. A pinguecula is a common, harmless yellowish patch found near the edge of the cornea, usually closer to the nose. A pterygium, sometimes called “surfer’s eye,” involves vascularized tissue that grows across the cornea’s surface in a wedge shape. Although rare, conjunctival malignant melanoma can appear as a brown or dark spot, requiring monitoring for any changes in pigmentation.
When a lesion affects the cornea, it disrupts the tissue’s normal clear structure, leading to opacity or ulceration. Keratitis, or corneal inflammation, results in a hazy, cloudy, or gray area on the surface. Viral infections, such as herpes simplex, can produce a characteristic branching pattern known as a dendritic ulcer. Any corneal lesion that causes a scratch or defect in the epithelium, the outer layer, is intensely painful and requires prompt attention.
Common Causes and Underlying Conditions
Eye lesions can be traced to various causes, ranging from a foreign body presence to complex systemic diseases. Infectious agents are a significant category. Bacteria like Staphylococcus and Streptococcus frequently cause localized infections such as styes and eyelid cellulitis. Viral infections are also common; adenoviruses cause contagious conjunctivitis, and herpes simplex is a leading cause of corneal ulcers. Fungi and parasites can cause rare but severe infections, such as fungal keratitis, often associated with contact lens wear or eye injuries involving plant matter.
Trauma is a direct cause of many eye lesions, ranging from a simple corneal abrasion caused by a foreign body to severe chemical burns or blunt injuries. Even minor physical impacts can cause internal bleeding or damage that manifests as a lesion. Environmental factors contribute to chronic changes; prolonged exposure to ultraviolet (UV) radiation is a risk factor for degenerative growths like pterygium and for skin cancers on the eyelids.
Lesions may also manifest an underlying health problem affecting the entire body. Systemic conditions like diabetes increase susceptibility to severe eye infections and impair healing, leading to persistent problems. Certain autoimmune disorders can cause inflammation, such as uveitis, which may lead to lesions on internal ocular structures. Some rare eyelid lesions, like sebaceous adenomas, are associated with syndromes that increase the risk of visceral malignancies, highlighting the eye’s role as an indicator of systemic disease.
Urgent Warning Signs and When to Seek Medical Help
While many lesions are minor, self-limiting issues, several specific symptoms demand immediate medical consultation. Sudden and unexplained loss of vision, whether partial or total, in one or both eyes indicates a potential emergency, such as retinal detachment or severe infection. Severe, unrelenting pain in or around the eye, not relieved by common medication, suggests a serious condition like acute glaucoma or a deep infection.
Any lesion that changes rapidly in size, shape, or color, or begins to bleed spontaneously, should be evaluated promptly for potential malignancy. Sensitivity to light (photophobia), especially combined with blurred vision or intense redness, signals serious inflammation of the cornea or the interior of the eye. The appearance of flashes of light, a shower of new floaters, or a curtain-like shadow across the field of vision suggests a retinal problem requiring emergency care to preserve sight.
Visible pus or a thick, colored discharge, particularly if accompanied by pain or decreased vision, indicates an active infection needing quick treatment. Changes in the size or responsiveness of the pupils can also signal internal eye injury or neurological involvement. If a person experiences chemical exposure or a penetrating injury, they must seek emergency medical attention immediately.
Diagnostic Procedures and Treatment Options
When a patient presents with a concerning eye lesion, the physician initiates a diagnostic process to identify the underlying cause and determine the extent of the damage. The most common tool is the slit lamp biomicroscope, which allows examination of the eye’s front structures under high magnification. Diagnostic swabs or scrapings are taken from the lesion or eye surface and sent to a laboratory to identify the specific bacterial, viral, or fungal organism causing an infection.
For lesions suspicious for malignancy or those involving internal structures, imaging techniques are employed. Ultrasound creates images of the eye’s interior using sound waves. Angiography involves injecting a fluorescent dye to highlight the vascular structure of the lesion. If a solid growth cannot be definitively identified as benign through clinical examination, a biopsy—the surgical removal of a small sample—is performed for pathological analysis.
Treatment is specific to the diagnosis, ranging from conservative management to advanced surgical intervention. Infectious lesions are often treated with topical medications, such as antibiotic, antiviral, or antifungal eye drops and ointments. Oral medications are necessary for aggressive infections like cellulitis or certain viral causes like herpes zoster. Benign growths that are symptomatic or cosmetically bothersome may be removed through minor procedures like curettage (scraping) or cryotherapy (freezing). Malignant lesions, such as basal cell carcinoma, require complex surgical techniques like excisional biopsy or Mohs micrographic surgery to ensure complete removal while preserving healthy tissue.