- Typically develops in middle-aged or elderly white patients.
- Almost always unilateral
- Uni- or multifocal, flat, indistinct areas of conjunctival pigmentation
- Commonly involves the inferior or superior fornices
- May remain stable over years, become smaller, undergo color changes or malignant transformation
- Work up: multiple biopsies are sometimes required to define the cytological status of the lesions.
- Regular follow-up with photographic documentation.
- Local excision with or without extensive cryotherapy should be performed if the lesion becomes thicker and demonstrates invasive nodular formation.