Objective: The objective of this study was to determine the relative frequency of histologically diagnosed conjunctival lesions at a tertiary hospital over a 12-month period. Methods: It was a prospective study in which all patients who presented to the ophthalmology clinic with suspicious conjunctival lesions between January and December 2022 were recruited. Data recorded were age, sex, duration of the growth and the affected eye. All the patients underwent basic ocular examination and an examination of the growth to document its site and size. Lesions were excised in the operating theatre under anaesthesia. The excised tissue was preserved in a formalin bottle and sent for histology. Data were entered into Excel and analysed using SPSS version 20.0. Results: A total of 73 eyes were recruited during the period of study. There were 41 males (56.2%) with M:F ratio of 1.3:1. Mean age was 38.44 ± 19.07 years with a range of 2–77 years. Forty patients (54.8%) presented with lesions in the right eye and 33 (45.2%) in the left eye. Fifteen types of conjunctival lesions were diagnosed, including pterygium 37%, conjunctival intraepithelial neoplasia 2.7%, melanoma 2.7%, ocular surface squamous neoplasia 4.1% and squamous cell carcinoma 4.1%, respectively. Conclusion: Pterygium was the most common benign lesion in this study. When conjunctival lesions appear suspicious, it is of utmost importance for the surgeons to differentiate between benign, premalignant and malignant lesions as this may aid in prompt patient management as well as better outcomes.