The gray-blue hyperpigmentation of this patient's periocular skin and the eye itself is consistent with a diagnosis of nevus of Ota, also known as oculodermal melanocytosis.
Scleromelanocytosis would feature an identical appearance of the eye but would not have the periocular skin findings.
Racial melanosis may demonstrate similar ocular features but would not have the periocular skin findings.
Nevus of Ito is a condition closely related to nevus of Ota, but it usually affects the shoulder area.
Scleromalacia, a condition characterized by thinning of the sclera, can present with what appears to be blue pigmentation of the eye. Areas of scleromalacia tend to have an elevated appearance. The blue pigmentation is the uvea showing through the thinned sclera.
The child will continue to be followed in the eye clinic. A dermatology evaluation was recommended to discuss the skin pigmentation.
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Cite this: A Child With Pigmentation of the Eye - Medscape - Oct 10, 2017.