Tumors in the eye can range from noncancerous tumors that originate in the eye to primary eye cancers and cancers that have spread from other parts of the body, especially the breast, lung, bowel or prostate.
Are eye tumors the same as eye cancer?
When some hear the diagnosis of an eye tumor, the first thought may be cancer. However, not all eye tumors are cancerous. If a tumor is benign, it does not spread to other parts of the body. The most common benign tumor in the eye is a choroidal nevus. Another eye tumor is a choroidal hemangioma, which is a vascular tumor. Although many of these benign tumors do not cause vision loss, if it is located in the macula — the central retina that provides detailed vision — patients can experience vision changes.
Cancerous Types of Eye Tumors
Malignant eye tumors may arise from several types of cancer, including:
- Uveal melanoma: An intraocular melanoma is one of the most common forms of eye cancer. It can develop in the iris, the ciliary body (region of the eye behind the iris that makes aqueous humor) or in the vascular choroid in the posterior eye. This form of eye cancer occurs most frequently in adults who are 60 years old or up. It is relatively rare; from 1,500 to 2,000 new cases are diagnosed annually in the United States.
- Intraocular lymphoma: This form of cancer is a rare form of lymphoma that starts in the eyeball.
- Eyelid tumors: The most common form of eyelid cancer is a skin cancer called basal cell carcinoma. There are also other types of eyelid tumors, such as a malignant melanoma, sebaceous cell carcinoma and squamous cell carcinoma. Most of these tumors can be removed with surgery.
- Conjunctival tumors: Lymphomas, melanomas, and squamous carcinomas are tumors that grow on the eye’s surface.
- Lacrimal gland tumors: This type of tumor grows in the tear glands.
- Retinoblastoma: This form of cancer is a cancer of the retina, the eye’s light-sensitive tissue. The most common childhood eye cancer, retinoblastoma usually develops in children under age 5, and affects about 200 children in the United States each year. In nearly one-third of the cases, retinoblastoma occurs in both eyes, due to a mutation in the RB1 gene. Parents often notice leukocoria, or white color to the pupil, as the first sign, which results from retinoblastoma tumors.
Symptoms of Eye Tumors
There are various symptoms of eye tumors, such as:
- Blurry vision or partial or total vision loss
- Seeing floaters or flashes of light
- Experiencing shadows or dark spots in vision
- Light sensitivity
- Lumps on the eyelid or other parts of the eye
- Changes in the shape of the pupil
- Bulging, redness or swelling of the eye
- Changes in the way the eye moves
- Pain in the eye
Some of these symptoms can be due to other health issues, so it’s important to talk to a health care provider. Only a doctor can determine whether the issue is an eye tumor.
Diagnosis of Eye Tumors
In addition to damaging a person’s vision, malignant eye tumors can spread to the optic nerve, the brain and the rest of the body. Therefore, early diagnosis and treatment are extremely important. Melanoma tends to spread through blood vessels to distant organs, especially the liver and lungs. Ophthalmologists and other highly skilled physicians, like the pathologist and oncologist, play a crucial role in making the precise diagnosis, treatment, and management plan.
When an eye tumor is suspected, the doctor will ask the patient about their family history of disease, risk factors, health history and symptoms before doing an eye exam. During the exam, the doctor will use an ophthalmoscope, a special scope with a light, to view the inside of the eye. They may also order other tests such as fundus photography and angiography, and fundus autofluorescence and echography, and may recommend a biopsy or vitrectomy. For children, much of the diagnostic workup may require an exam under anesthesia.
If the ophthalmologist diagnoses the patient with eye cancer, he or she will work to learn more about the cancer to determine how much and how far the tumor has progressed. The workup may include blood work and a CT, MRI, or PT scan. The doctor will then talk to the patient about the cancer’s spread, what it means in the near future, and what treatment options are available. Patients should ask their ophthalmologist to explain the condition in a way that will make sense to them.
Treatment of Tumors in the Eye
There are various ways to treat eye tumors, depending on the diagnosis, size and aggressiveness of the tumor and other factors. In some cases, the tumor grows slowly, and because treatments affect vision, the doctor may recommend against immediate treatment. If this is the case, the doctor will monitor the tumor, and the patient will receive treatment later if it grows or causes problems.
If the tumor requires treatment, there are multiple options. Certain small tumors may respond to laser treatment. Some specialists may recommend thermotherapy, a procedure that uses a laser to heat the tumor in order to destroy the cancer cells, or cryosurgery, which freezes the tumor to remove the cancer cells. In some instances, it is possible to remove a tumor surgically and still preserve vision.
For melanomas, the most common surgery used is to place a “plaque” of radiation on the eye overlying the tumor. After four days, the plaque is removed. During the surgery, a biopsy is often acquired so the melanoma can be classified into high, medium or low risk for metastatic spread. With plaque treatment, the success rate is about 80%–85%.
If the eye cancer is advanced and must be treated aggressively or removed, plastic surgeons at Wilmer Eye Institute, Johns Hopkins Medicine remove the eye. Today, artificial eyes or implants move almost normally and are virtually indistinguishable from natural eyes, although, of course, they do not see. Generally speaking, eye tumors are treated by the retina division with assistance from Johns Hopkins oncologists, radiation oncologists, pediatric oncologists, and interventional radiologists.