Because of various contributing factors such as exposure to ultraviolet (UV) light, especially UV type B radiation, and the high prevalence of human immunodeficiency virus (HIV) infection in South Africa, medical practitioners are often consulted by patients with conjunctival growths. However, the diagnosis of conjunctival lesions is challenging, and it may be difficult to clinically distinguish between benign and malignant lesions. The aim of this article is to present a synopsis of conjunctival growths, and propose a practical approach to making the correct diagnosis and implementing appropriate management.