Focal Scleral Nodule (FSN)

Types / Variants and Important Differentials
Causes
Symptoms and Clinical Clues
Diagnostic Tests
Non-Pharmacological Treatments
Drug Treatments
Dietary Molecular Supplements
Regenerative / “Hard Immunity” / Stem Cell–Related Therapies
Surgical or Procedural Interventions
Preventions
When to See a Doctor
What to Eat and What to Avoid
Frequently Asked Questions (FAQs)

A focal scleral nodule is a small, round, benign lump that grows from the white outer coat of the eye called the sclera. It usually looks yellowish or white, is slightly raised, and is most often found behind the equator of the eyeball (the back half). These nodules are not cancer. They were first described under other names (like “unifocal helioid choroiditis”) but later imaging showed they actually start in the sclera, so the name was changed to focal scleral nodule. Most do not cause problems and do not need treatment. EyeWiki

A Focal Scleral Nodule (FSN) is a small, well-defined, benign lump located within the sclera, the white outer coat of the eye. It appears as a yellow-white or pale lesion, usually slightly elevated, and is most often located behind the equator of the eye, sometimes near the optic nerve. On clinical exam and imaging—including optical coherence tomography (OCT)—the lesion is localized to the sclera, which distinguishes it from deeper intraocular tumors such as amelanotic choroidal melanoma or metastasis. Most people with an FSN have no symptoms, and the lesion is often found incidentally during routine eye examinations or imaging. The natural course is benign; vision is usually unaffected, and the lesion typically remains stable over time.EyeWiki PMC djo.harvard.edu

Because the exact reason why these nodules appear is not fully known, FSN is considered idiopathic in most cases—meaning it happens without a clear cause. Some studies have explored possible links with other conditions (like tuberculosis, syphilis, sarcoidosis, cat scratch disease, and viral exposures), but those associations remain uncertain and have not been consistently confirmed. EyeWiki

FSNs tend to be stable over time; many stay the same size and appearance for years. Rarely, they can change—some slowly grow, others fade. Because their appearance can resemble more serious illnesses (like tumors), it is important to examine and image them carefully to be sure of the diagnosis. EyeWiki

Types / Variants and Important Differentials

FSN itself is a single clinical entity, but it can appear in slightly different shapes: most are dome-shaped, but some are nodular or even volcano-shaped. They typically push on the overlying tissues, causing thinning of the layer just above (the choroid), which gives them their pale appearance on exam. EyeWiki

Because FSN can look like other eye problems, doctors always consider a differential diagnosis—a list of conditions that can mimic its appearance. Important close look-alikes include serious conditions such as choroidal melanoma, metastasis, lymphoma, or granulomatous lesions (e.g., from tuberculosis or sarcoidosis), as well as benign entities like sclerochoroidal calcification. High-resolution imaging (especially optical coherence tomography) helps distinguish true FSN from these mimics. EyeWikiScienceDirect

Two related inflammatory conditions that produce nodules on the sclera are nodular scleritis and infectious scleritis. Nodular scleritis is a form of deep inflammation of the sclera often tied to systemic autoimmune disease; it causes a tender, red, painful lump and can threaten vision if not treated. Infectious scleritis arises from microbes invading the sclera and may look similar early on but requires very different treatment. Distinguishing these from FSN is critical because FSN usually causes little or no pain and is not destructive, whereas scleritis is painful and potentially vision-threatening. Merck ManualsNCBIPMCFrontierstouchOPHTHALMOLOGY

Causes

Important clarification: Focal scleral nodule itself is most often idiopathic, but the following list includes (a) conditions or exposures that have been proposed or weakly associated with FSN, and (b) other diseases that produce similar-appearing scleral or sclerochoroidal nodules (i.e., mimics or differential diagnoses). Each is explained so a reader can understand why it is relevant.

Idiopathic origin (true FSN) – Most FSNs arise without any known trigger. The lesion simply develops, likely from an unexplained internal process in the sclera. EyeWiki
Congenital/developmental predisposition – Some data suggest these nodules may start very early in life, possibly before birth, in a subset of patients, implying a developmental origin in some cases. EyeWiki
Tuberculosis-related granuloma (ocular TB) – Tuberculosis can cause granulomatous inflammation in the eye; such granulomas can look like or overlap with scleral/choroidal nodules. EyeWikiScienceDirect
Syphilis – The systemic infection syphilis can involve the eye and create lesions that mimic or confuse the picture of a scleral/choroidal nodule. EyeWiki
Sarcoidosis – This inflammatory disease can create granulomas in ocular tissues, sometimes producing lesions similar to FSN or coexisting in the differential. EyeWikiScienceDirect
Cat scratch disease (Bartonella henselae) – Animal exposure has been suggested in case series as a possible association with solitary ocular inflammatory nodules, though this link remains unsettled. EyeWiki
Coxsackie virus exposure – Viral infections like coxsackie have been proposed (in exploratory reports) as triggers for certain solitary ocular inflammatory lesions that were historically mischaracterized before FSN terminology. EyeWiki
Rheumatoid arthritis – A systemic autoimmune disease that frequently causes nodular scleritis; such nodules must be distinguished from FSN. NCBIMedscape
Systemic lupus erythematosus (SLE) – Another autoimmune disorder that can cause deep ocular inflammation, including scleritis-like nodules. NCBIMedscape
Granulomatosis with polyangiitis (Wegener’s) – A vasculitis that can involve the sclera and produce nodular inflammatory lesions. Medscape
Relapsing polychondritis – Cartilage inflammation that may have ocular manifestations including scleral inflammation; nodules of inflammatory origin can appear. Medscape
Polyarteritis nodosa and other systemic vasculitides – Inflammation of medium-sized vessels may extend to adjacent ocular structures causing scleral involvement. Medscape
Infectious scleritis due to Pseudomonas or other bacteria – Bacterial invasion can cause deep, painful scleral nodules (often with discharge and severe inflammation), a critical mimic because the treatment differs. PMCNCBIAnnals of Translational Medicine
Fungal infection (e.g., Aspergillus, Candida) – Fungal pathogens can invade the sclera, especially after surgery or trauma, causing nodular lesions that resemble scleritis or mimic other nodules. NCBI
Herpes zoster ophthalmicus (reactivation of VZV) – Viral reactivation in the distribution of the trigeminal nerve can inflame deep ocular tissues, occasionally producing nodular findings. touchOPHTHALMOLOGY
Surgically induced necrotizing scleritis (SINS) – Trauma from prior eye surgery can provoke a localized destructive inflammation that appears as nodules or thinning in the sclera. Cleveland Clinic
Choroidal melanoma (mimic) – Though not a cause of FSN, this intraocular tumor can look similar in early appearance; distinguishing it from a benign FSN is essential to avoid missing a malignancy. EyeWiki
Choroidal metastasis (mimic) – Spread of cancer from elsewhere in the body to the eye can create lesions that mimic FSN on a basic exam. Imaging helps differentiate. EyeWiki
Choroidal lymphoma (mimic) – Lymphoma involving the eye can present as a plaque-like or nodular lesion, and needs to be considered in the differential. EyeWiki
Sclerochoroidal calcification (mimic) – Calcium deposits in the sclera/choroid can look like FSN, but imaging (especially B-scan ultrasound) shows distinctive internal reflectivity. EyeWikiScienceDirect

Symptoms and Clinical Clues

FSN itself often causes no symptoms, but when it does or when similar conditions are present, the following symptoms may be reported. Many symptoms overlap with inflammatory or infectious scleral nodules, so context and examination matter.

No symptoms / asymptomatic finding – Most FSNs are found during routine eye exams because they do not bother the person. EyeWiki
Blurry vision – If the lesion is near or affects the macula or distorts nearby structures, vision may become slightly fuzzy. EyeWiki
Floaters – Patients sometimes report seeing spots or shadows, especially if subtle adjacent retinal changes exist. EyeWiki
Visible lump or elevation in the eye (noticed by eye doctor) – Clinically seen as a round, elevated yellow-white area on fundus exam. EyeWiki
Eye redness – More common when inflammation is present (as in nodular scleritis or infectious variants), not typical for inactive FSN. Merck ManualsNCBI
Eye pain – Severe pain is a hallmark of true scleritis; FSN usually causes little or no pain, so significant pain should prompt looking for scleritis or infection. NCBIMerck Manuals
Tenderness to touch – Suggests deeper inflammation (scleritis) rather than benign FSN. NCBICleveland Clinic
Photophobia (light sensitivity) – Often seen in inflammatory scleral disease; not common with quiet FSN. Merck ManualsNCBI
Tearing / watering of the eye – Reflex tearing can accompany irritation or inflammation. Cleveland Clinic
Discomfort with eye movement – Classic for scleritis due to involvement of adjacent muscles or deep tissues; less so for FSN. NCBIMerck Manuals
Foreign body sensation – Feels like something is in the eye, usually with irritation or mild surface inflammation. Cleveland Clinic
Localized scleral thinning or bluish hue – Advanced inflammatory processes can thin the sclera, revealing underlying tissues. Not typical in inactive FSN but seen in severe scleritis. Merck ManualsNCBI
Conjunctival or episcleral vessel congestion – Redness in specific patterns may help differentiate between superficial (episcleritis) and deep (scleritis) causes. touchOPHTHALMOLOGY
Systemic symptoms (joint pain, fatigue, fever) – When a systemic autoimmune or infectious disease is the underlying driver, patients may also have body-wide signs. Medscape
Changes in vision quality related to distortion of nearby structures – Subtle alteration in the architecture of the macula or retinal pigment epithelium caused by a nearby lesion may produce visual complaints. EyeWiki

Diagnostic Tests

Below are 20 key diagnostic assessments to evaluate a focal scleral nodule or distinguish it from inflammatory, infectious, or neoplastic mimics. Each is described with its role in simple terms.

A. Clinical / Physical / Manual Examination

Visual acuity test – Measures how clearly a person can see. It establishes if the lesion affects vision and provides a baseline to track change. Medscape
Slit-lamp examination – A special microscope that lets the doctor see the front of the eye and parts of the sclera in detail to check for redness, swelling, or adjacent inflammation. NCBIMerck Manuals
Fundoscopic (ophthalmoscopic) exam – Viewing the back of the eye to directly see the nodule, its color, borders, and relation to the retina or optic nerve. EyeWiki
Palpation for tenderness and pressure (gentle external pressure) – Applying slight pressure around the eye to evaluate whether the area is painful, helping distinguish scleritis (tender) from FSN (usually non-tender). NCBIMerck Manuals
Ocular motility and pain with movement testing – Asking the patient to move their eye to see if motion causes discomfort, which is characteristic of scleritis but not of a quiet FSN. NCBIMerck Manuals
Scleral indentation / manual depth assessment – A controlled technique to feel the lesion’s depth and assess its fixation versus mobility; helps differentiate between superficial and deeper lesions. Ento Key

B. Laboratory and Pathological Tests

Autoimmune panel (ANA, rheumatoid factor) – Checks for common antibodies linked to systemic diseases like lupus or rheumatoid arthritis that often cause inflammatory scleral nodules. NCBIMedscape
ANCA (anti-neutrophil cytoplasmic antibodies) – Used when vasculitis (such as granulomatosis with polyangiitis) is suspected as a driver of scleral inflammation. Medscape
ACE level (angiotensin converting enzyme) – Elevated in some cases of sarcoidosis, a disease that can produce eye granulomas mimicking FSN. ScienceDirect
Syphilis serology (RPR, FTA-ABS) – Blood tests to detect syphilis, which can involve the sclera and masquerade as other nodular lesions. EyeWiki
Tuberculosis testing (PPD skin test or IGRA blood test) – Evaluates latent or active TB as a possible cause of ocular granulomatous disease. ScienceDirect
Bartonella henselae serology – Checks for cat scratch disease exposure when that association is under consideration for idiopathic-like ocular lesions. EyeWiki
Viral PCR (e.g., herpes zoster virus) – Detects active viral DNA if viral causes are suspected, especially when inflammation or pain is prominent. touchOPHTHALMOLOGY
Scleral/ocular tissue biopsy with histopathology – Taking a small tissue sample for microscopic examination is essential when the lesion’s nature (benign vs malignant vs inflammatory/infectious) is unclear. EyeWiki
Microbial cultures (bacterial/fungal) from scleral scrapings – Grown in lab to identify specific bacteria or fungi in infectious scleritis, guiding proper antimicrobial therapy. NCBIAnnals of Translational Medicine

C. Electrodiagnostic Tests

Visual evoked potentials (VEP) – Measures how the brain responds to visual stimuli. Used if there is concern that deeper inflammation or nearby disease is affecting the optic nerve or visual pathway. Medscape
Electroretinography (ERG) – Evaluates retinal function; considered when secondary effects on the retina are suspected from a nearby lesion. Medscape

D. Imaging Studies

Optical coherence tomography (OCT), including enhanced depth imaging – High-resolution cross-sectional images of the back of the eye show whether the lesion arises from the sclera (as in true FSN) versus the choroid, and demonstrate its shape and effect on overlying tissues. EyeWiki
B-scan ultrasonography – Uses sound waves to see deeper structures; helpful to distinguish calcification (which shows bright echoes) from a soft FSN, and to detect any extension of inflammation. EyeWikiScienceDirect
MRI of the orbit with contrast – Provides a detailed look at the lesion’s boundaries, rule out extension into adjacent tissues, and help separate inflammatory/infectious causes from tumors. FrontierstouchOPHTHALMOLOGY

Non-Pharmacological Treatments

(Note: For a true focal scleral nodule, the standard “treatment” is observation. The following 20 non-drug approaches are either the actual management for FSN (e.g., monitoring) or supportive/preventive strategies commonly used in ocular surface and inflammatory differential diagnoses to ensure safety and optimal eye health.)

Observation with periodic imaging – Most FSNs do not change; scheduled follow-up (e.g., every 6–12 months initially) with OCT or photography ensures stability.EyeWikidjo.harvard.edu
Patient education – Informing the patient that the lesion is benign, what symptoms would warrant return, and reducing anxiety prevents unnecessary interventions.
High-resolution multimodal imaging – Using OCT, fundus autofluorescence, and B-scan to document and compare over time helps distinguish benign stability from worrisome change.djo.harvard.eduResearchGate
Avoidance of eye rubbing and mechanical trauma – Protects the eye from irritation that could confound exam findings or provoke unrelated inflammation.
UV eye protection – Sunglasses with UV filtering protect the eye and support general ocular health; chronic UV exposure contributes to ocular surface stress.
Dry environment management – Using humidifiers or avoiding extreme dryness reduces secondary surface irritation that might cloud imaging or mimic symptoms.
Warm compresses for related surface discomfort – If the patient has concurrent mild ocular surface dryness, warm compresses can relieve superficial irritation (not for FSN per se).
Lubricating artificial tears – Supports ocular surface clarity so the clinician can better visualize the lesion and reduces misleading redness from dryness.
Avoidance of unnecessary contact lens overwear – Minimizes superimposed redness or irritation that could be confused with pathology.
Systemic disease screening when indicated – If signs suggest inflammation (e.g., disproportionate redness or pain), evaluate for autoimmune diseases like rheumatoid arthritis or lupus.Merck ManualsFrontiers
Infection control hygiene – Good eyelid hygiene reduces confounding infections that could produce nodular-appearing lesions.
Smoking cessation – Smoking promotes chronic ocular surface inflammation and vascular changes; quitting supports better ocular immunity and health.
Blood pressure and diabetes control – Vascular stability aids in clearer ophthalmic assessment and reduces secondary risks that might complicate interpretation.
Stress reduction / sleep hygiene – Chronic stress and poor sleep can worsen systemic inflammation (which may exacerbate mimicking conditions).
Avoidance of self-medication with over-the-counter steroid drops unless prescribed – Improper steroid use can mask or worsen true inflammatory mimickers like scleritis.
Use of protective eyewear in high-risk environments – Prevent accidental trauma that may complicate the ocular exam.
Second opinion or referral to ocular oncology when uncertain – Ensures rare malignancies are not missed when lesion characteristics are ambiguous.EyeWikidjo.harvard.edu
Documentation of systemic symptoms – Recording any systemic joint pain, skin changes, or fatigue can help catch an autoimmune process early if the ocular appearance evolves.
Avoidance of unnecessary ocular surgeries nearby without full evaluation – Prevents post-procedural inflammation that could be misattributed or mask true changes.
Use of noninvasive imaging review boards or multidisciplinary case discussion for atypical lesions – Helps distinguish rare mimics from FSN, improving diagnostic confidence.

Drug Treatments

Important: A true focal scleral nodule usually does not require any drug therapy. The following drug treatments are relevant when the lesion is misdiagnosed as, or coexists with, inflammatory or infectious scleral disease (e.g., nodular scleritis, autoimmune scleral inflammation, or infectious scleral nodules).

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Drugs like ibuprofen or indomethacin are first-line for mild non-infectious scleral inflammation; they reduce pain and inflammation by inhibiting COX enzymes. Dosage is standard (e.g., ibuprofen 400–600 mg every 6–8 hours with food). Side effects include gastric irritation, renal effects, and bleeding risk.PMC
Oral corticosteroids (e.g., prednisone) – Used for moderate to severe non-infectious scleritis to suppress immune-mediated inflammation; typical starting doses range from 0.5 to 1 mg/kg/day with taper. Side effects include weight gain, blood sugar rise, mood changes, and immunosuppression.Merck ManualsMedscape
Topical corticosteroids (e.g., difluprednate, loteprednol) – May be used when surface or adjacent inflammation exists; penetration is variable and they are used cautiously to avoid raising intraocular pressure.Ento Key
Immunosuppressive steroid-sparing agents (e.g., methotrexate, mycophenolate mofetil, azathioprine) – For chronic or refractory non-infectious inflammatory scleral disease, these reduce reliance on systemic steroids. They require monitoring of liver/kidney function and blood counts.PMCMedscape
Biologic agents (e.g., infliximab, adalimumab, tocilizumab) – Used in refractory autoimmune scleritis when conventional immunosuppression fails; they target specific cytokines (TNF-alpha, IL-6) to modulate immune response. Risks include infection reactivation and infusion reactions.Frontiers
Antibiotic therapy (targeted) – In infectious scleral nodules (bacterial, fungal), microbiology-guided systemic and/or topical antibiotics (e.g., fortified topical antibiotics, systemic antifungals) are used; the drug class and duration depend on organism.PMC
Antitubercular therapy – If ocular tuberculosis produces a scleral granulomatous nodule, standard multi-drug anti-TB therapy is instituted per infectious disease guidelines.PMC
Antiviral therapy (e.g., for herpetic scleritis) – When viral etiology is suspected, agents like oral acyclovir are used to suppress viral replication.
Systemic disease–specific therapy – If underlying systemic autoimmune disease (e.g., rheumatoid arthritis) drives scleral inflammation, disease-modifying antirheumatic drugs (DMARDs) are optimized in coordination with rheumatology.Merck ManualsMedscape
Adjunctive pain control (e.g., low-dose opioids or neuropathic agents) – Reserved for severe pain in scleral inflammation not responsive to anti-inflammatories, used briefly with caution.

(Each of these should be clearly labeled on any publication as pertaining to inflammatory or infectious mimics, not routine FSN management.)

Dietary Molecular Supplements

These supplements have evidence for supporting eye surface health or reducing inflammation; none are specific cures for a focal scleral nodule, but they help overall ocular resilience and lower risk of confounding inflammatory conditions.

Omega-3 fatty acids (EPA/DHA) – Typical dose for dry eye/inflammation ranges from 1000 to 3000 mg combined EPA/DHA daily. They modulate inflammatory eicosanoid production, improving tear film quality and reducing ocular surface inflammation. Evidence is mixed but some trials show symptom improvement.PMCPMCLippincott Journals
Lutein and Zeaxanthin – Doses around 10 mg lutein + 2 mg zeaxanthin daily support macular health and act as antioxidants to reduce oxidative stress in ocular tissues. They may delay progression of age-related damage.PMCPMCFrontiers
Vitamin C – An antioxidant found in many fruits; may support collagen and scleral tissue health indirectly by reducing oxidative stress.Verywell Health
Vitamin E – Lipid-soluble antioxidant that guards cell membranes from oxidative damage; supplement roles in eye health are supportive, especially combined with other ocular nutrients.Verywell Health
Zinc – Important in retinal metabolism and antioxidative defense; part of AREDS formulations for macular disease and may help maintain general ocular tissue integrity.Verywell Health
Astaxanthin – A carotenoid with anti-inflammatory and antioxidant properties; emerging data suggest benefits for eye fatigue and possibly ocular surface protection (the evidence is growing but less established).
Curcumin (with enhanced bioavailability) – Natural anti-inflammatory agent that modulates NF-kB and cytokines; has theoretical benefit in lowering mild ocular inflammation when systemic inflammation is present.
Bilberry extract (anthocyanins) – Traditionally used for microvascular support; limited evidence suggests minor benefit in visual comfort and protection from oxidative stress.
Vitamin D – Immune system modulator; deficiency has been associated with increased ocular surface inflammation in some observational studies.
Probiotics / gut microbiome support – Indirectly influence systemic inflammation and immune balance, which can reduce risk of immune-mediated ocular surface disorders.Verywell Health

Note on supplementation: Always check with an eye doctor or primary care physician before starting new supplements, especially if the patient is on other medications or has systemic disease. Some (e.g., high-dose zinc or vitamin E) can interact or have side effects; smokers should avoid beta-carotene supplements due to lung cancer risk.Verywell Health

Regenerative / “Hard Immunity” / Stem Cell–Related Therapies

There is no approved stem-cell drug specifically for focal scleral nodules, but in the broader realm of ocular surface and immune-mediated scleral inflammation, regenerative strategies are being studied or used:

Autologous serum eye drops (ASEDs) – Prepared from the patient’s own blood; rich in growth factors and tear-like components, they promote healing of ocular surface epithelium and reduce inflammation in dry eye or surface compromise. Typical concentrations are 20% serum diluted in saline, instilled multiple times daily. Evidence shows improved tear film metrics in moderate-to-severe disease.PubMedPMCFrontiers
Platelet-rich plasma (PRP) eye drops – Similar concept to serum drops but with higher platelet-derived growth factors; used in refractory ocular surface disease to stimulate repair. Evidence is emerging, often applied in cycles.MDPI
Mesenchymal stem/stromal cell (MSC) systemic or local therapy – Experimental for autoimmune ocular inflammation (e.g., uveitis, scleritis) due to their immunomodulatory and anti-inflammatory secretions. Trials show potential in reducing pathogenic immune activity and promoting tissue repair; delivery routes vary (intravenous, periocular).PMCPMCWiley Online Library
MSC-derived exosomes (MSC-Exo) – Small vesicles carrying immunoregulatory signals; early preclinical models (e.g., autoimmune uveitis) suggest they can suppress inflammation without whole-cell administration.Frontiers
Genetically enhanced MSCs (e.g., CCR5-overexpressing) – Research-level approach showing improved control of immune-mediated eye inflammation in animal models (e.g., experimental autoimmune uveitis), offering insight into future targeted regenerative immune modulation.BioMed Central
MSC therapy for associated autoimmune lacrimal/orbital conditions – For diseases like autoimmune dacryoadenitis (which can accompany broader ocular inflammation), MSCs have been explored for their dual role in immune damping and tissue support.BioMed Central

Clinical note: These approaches are largely investigational for inflammatory eye disease and are used in specialized centers. They are not routine for focal scleral nodules but may be relevant if overlapping autoimmune inflammation is present.

Surgical or Procedural Interventions

FSN itself almost never needs surgery. The following are procedures for severe mimickers or complications:

Excisional biopsy – When diagnostic uncertainty remains (e.g., rule out melanoma or metastatic lesion), a small tissue sample may be surgically removed for histopathology.ResearchGate
Scleral patch graft / tectonic graft – Used in severe inflammatory scleral thinning or necrosis (e.g., in aggressive scleritis) to restore structural integrity of the globe.Merck Manuals
Amniotic membrane transplantation – A regenerative surface procedure for ocular surface breakdown that can accompany severe inflammatory disorders; promotes healing via growth factors.MDPI
Referral to ocular oncology for guided laser or local therapy – If lesion proves neoplastic or equivocal, targeted local therapy (depending on pathology) may be pursued after diagnosis.djo.harvard.edu
Surgical debridement with microbiologic sampling – In infectious scleral nodules where necrotic tissue is present, debridement alongside culture guides antimicrobial therapy.PMC

Preventions

Because focal scleral nodules are idiopathic and usually benign with unknown exact triggers, specific prevention is not clearly defined. However, the following general measures reduce risk of misdiagnosis, superimposed inflammatory insults, and ocular complications:

Regular comprehensive eye exams – Early detection and monitoring prevent confusion with dangerous lesions.
Prompt treatment of ocular infections – Prevent development of infectious scleral nodules or secondary inflammation.PMC
Control of systemic autoimmune conditions – Good management of diseases like rheumatoid arthritis or lupus reduces risk of inflammatory scleral disease.Merck ManualsMedscape
Avoid self-medicating with steroids without supervision – Prevents masking true pathology or inducing steroid-related complications.
Protective eyewear in trauma risk environments – Prevents mechanical insults that could be mistaken for or aggravate scleral findings.
Avoid smoking – Reduces chronic ocular surface stress and systemic inflammation.
Good eyelid and ocular hygiene – Lowers risk of surface disease that complicates interpretation.
Healthy diet supporting eye health – Nutrient-rich eating supplies antioxidants and reduces systemic inflammatory burden.Verywell Health
UV protection – Limits cumulative stress to ocular tissues that might confuse exam findings.
Timely referral when symptoms evolve – Avoids delayed diagnosis of an emerging or overlapping condition.

When to See a Doctor

Even though FSN is typically harmless, return to a doctor or specialist is warranted if any of the following occur:

New or worsening eye pain (especially deep, aching pain).
Redness that increases or extends beyond the usual mild background (could signal scleritis).Merck Manuals
Decreased vision or visual distortion.
Noticeable growth or change in the lesion’s appearance on self-photographs or by clinician comparison.
Light sensitivity (photophobia) that is new.
Tearing not explained by surface dryness.
Signs of systemic autoimmune flare (joint pain, skin rashes) concurrent with ocular changes.
Fever or systemic signs of infection with ocular discomfort.
Persistent ocular surface irritation not responding to simple lubricants.
When a previous conservative plan has not shown stability on follow-up imaging.djo.harvard.eduMerck Manuals

What to Eat and What to Avoid

Eat (supportive for eye health and inflammation control):

Leafy green vegetables (spinach, kale) – High in lutein/zeaxanthin.PMC
Fatty fish (salmon, sardines) – Provide omega-3s (EPA/DHA) that reduce ocular surface inflammation.PMCPMC
Citrus fruits and berries – Vitamin C for antioxidant defense.Verywell Health
Nuts and seeds – Provide vitamin E and zinc precursors.Verywell Health
Eggs – Source of lutein/zeaxanthin in bioavailable form.
Whole grains – Support systemic metabolic health and reduce chronic inflammation.
Colorful vegetables – Carotenoids and polyphenols help ocular resilience.
Lean proteins – For tissue repair and immune balance.
Hydration (adequate water intake) – Maintains tear film and surface lubrication.
Probiotic-rich foods – Support gut–immune axis, lowering systemic inflammatory tone.

Avoid:

Excessive sugar / refined carbs – Promote systemic inflammation and poor microvascular health.
Trans fats / processed fried foods – Increase oxidative stress.
High sodium intake – May worsen blood pressure and ocular vascular health.
Excessive alcohol – Dehydrates mucosal surfaces including the eye.
Smoking – Directly damages ocular tissues and impairs healing.
Unsupervised high-dose single-nutrient supplementation (e.g., high-dose beta-carotene in smokers) – May have unintended risks.Verywell Health
Highly allergenic foods if patient has known ocular allergic flares – Can exacerbate periocular inflammation indirectly.
Dehydrating beverages in excess (e.g., high-caffeine without hydration) – May worsen dryness symptoms.
Excessive mercury-containing fish – Choose low-mercury sources when consuming fatty fish.
Foods that trigger systemic autoimmune flares (individualized) – Some patients note triggers; a diary can help identify them.

Frequently Asked Questions (FAQs)

What is a focal scleral nodule?
It is a small, benign lump in the white part of the eye (sclera) that usually causes no symptoms and is found by chance.EyeWikiPMC
Is it cancer?
No. In its classic form, a focal scleral nodule is not cancerous. However, doctors use imaging or biopsy only if the appearance is unusual to rule out serious lesions.djo.harvard.eduResearchGate
Will it make me lose vision?
Almost never. The lesion itself is benign and rarely affects vision. If vision changes, it must be evaluated for other causes.EyeWiki
Does it need treatment?
In most cases, no treatment is needed—just monitoring. Interventions are only for other conditions that look similar.EyeWikidjo.harvard.edu
How is it monitored?
Through regular eye exams and imaging such as OCT or photos to ensure it stays the same.djo.harvard.edu
Can it become inflamed or infected?
The nodule itself is not typically inflamed or infected; if redness, pain, or other symptoms appear, evaluation is required to rule out overlapping inflammatory conditions like scleritis.Merck ManualsPMC
What other conditions can mimic it?
Amelanotic melanoma, nodular scleritis, infectious scleral nodules, and certain granulomatous diseases.Merck ManualsPMC
Do I need a biopsy?
Only if imaging and clinical exam cannot confidently exclude malignancy or an aggressive inflammatory cause.ResearchGate
Can diet help?
Eating foods that support eye health (e.g., leafy greens, omega-3s, antioxidants) can help overall ocular resilience but does not shrink the nodule.PMCPMC
Should I take supplements?
Some supplements like omega-3s and lutein/zeaxanthin support eye surface and retinal health; discuss with your doctor before starting.PMCPMC
What symptoms should prompt immediate care?
New eye pain, vision loss, increasing redness, or any change in the lesion’s size or appearance.Merck Manualsdjo.harvard.edu
Is it hereditary?
There is no known inherited pattern; it appears sporadically.ResearchGate
Can it go away by itself?
It usually stays the same; spontaneous resolution is uncommon but stability is expected.EyeWiki
Can it be mistaken for scleritis?
Yes, careful clinical and imaging evaluation distinguishes the painless, stable FSN from inflamed, painful scleritis.Merck ManualsEnto Key
Do I need to see a specialist?
If there is uncertainty, growth, symptoms, or atypical appearance, referral to an ocular oncologist or uveitis/scleral inflammation specialist is appropriate.djo.harvard.eduFrontiers

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