J.B. is a 55 y/o white male who'd been followed in our clinic for several years. He presented last year for a routine exam. His only complaint was a little blurred vision near and far.

Examination was straight-forward, with good vision obtained after refraction. Cornea was clear, A/C deep and clear, lens O.K., and upon dilated retinal evaluation, normal retinal health was seen. IOP was fine as well.

Ok... everything looked fine, except when I pull down the lower lid on slit-lamp examination, the dark conjunctival area you see in the photograph was found. When asked about it, J.B. reported he had never seen it and was very surprised when we showed him a poloroid of the lesion.

What is this lesion? How should be patient be managed? What sort of sequelae may result if this is handled properly? These are some open ended sort of questions, but ones I'd like you to think about. Once you've made your decision, we'll discuss things a bit more in the answer.

Please take the time to participate. The more that join in, the better the experience will be for all.

Thanks!

Walt Mayo, OD