Bilateral nevus of Ota – A rare clinical presentation

Abstract

Nevus of Ota is a rare congenital hamartoma of the dermal melanocytes causing a blue-grey hyperpigmentation of the eye and adnexa. The condition is usually unilateral but rarely it can be bilateral. A 28-year-old lady from West Bengal, India, visited the Ophthalmology outpatient department with the complaints of blackish discoloration of left side of the face and periorbital region. On examination, a large (5x6 cm) lesion was noted on the skin of the left side of face, forehead, sclera, lower palpebral conjunctiva, ala of nose, hard palate along with sclera and iris of the right eye. Cutaneous examination revealed that the lesion is unilateral diffuse, homogenous, blue-gray colored macular pigmentation with ill-defined borders. The lesions do not undergo spontaneous regression, but the intensity of the blue-black discolored lesions may vary during menstruation, fatigue or change in weather. The patient needs to be followed up annually, checking at each visit for visual acuity, biomicroscopy, intraocular pressure, gonioscopy and fundus examination. A thorough knowledge of the disease process, possible complications and screening protocol can help the ophthalmologist to pick up sight threatening complications early, initiate prompt treatment which may avert possible visual loss.