April 23, 2013

We have all been touched by cancer; we all have a friend, coworker, family member, or personal experience with cancer and the havoc it can bring to our lives. There are over one hundred types of cancer, many of which can be devastating in the damage they cause. Cancer is characterized by an abnormal growth of cells. Many cancers are detected through routine self-examinations, but often are not noted until a medical professional’s examination or screening. Treatments can include chemotherapy, radiation, and surgical intervention. While we all may be aware of more common systemic cancers (like breast, colon, prostate, and skin cancers), we would like to focus on two types of eye cancers: retinoblastoma and melanoma.

While eye cancers may be less common, but they are no less potentially deadly; routine eye examinations are a key factor in the screening for many eye conditions, including ocular cancers. The American Cancer Society estimates that there are 2,800 new cases of cancers (primarily melanoma) of the eye and orbit annually: 1,490 in men and 1,310 in women; 320 people with an active ocular cancer will die annually.


The most common type of ocular cancer in adults is melanoma (followed closely by lymphoma). Ocular melanoma may begin on the lid, the brow, the iris (the colored part of the eye), or, most often, in the choroid, a vascular area of the eyeball which sits between the retina and the sclera. While cancers of the iris, lids, and brow are often very easy for patients to visibly see (many times they will start as a pigmented spot, bump, or lesion that grows over time), choroidal cancers require a medical examination to be fully viewed.
Signs of cancers of the skin surrounding the eye (lids, brow, etc) are often very easy to note as they are frequently visible to the naked eye. Lid cancers may begin as a discoloration on the lid and progress to a raised bump or active lesion, or they may remain as a discolored area of the lid. In either case, evaluation and treatment is required; evaluation of the affected area should occur as soon as you notice a change, have a concern, or are referred by another doctor, friend, or family member for ophthalmic evaluation. Cancers of the skin surrounding the eye are highly treatable, especially when caught early on in the disease.

Signs of intraocular melanoma include a pigmented spot on the eye, blurred vision, a change in vision, loss of vision, headaches, and a change in the shape of the pupil. Intraocular tumors may cause glaucoma as they can cause tension and separation on the retina; patients with active glaucoma caused by a tumor (not “normal” glaucoma) may note eye pain, redness, nausea, headaches, and blurred vision. If you notice any of the above symptoms, an examination with your ocular medical professional is essential. Your exam may consist of: dilation of the pupil (this gives the doctor a better view of your eye), ultrasound exam of the eye (which uses sound waves to provide a picture of the inside of the eye), and transillumination of the eye (wherein a light is used to examine the eye).

There are many factors which increase the risk of developing intraocular melanoma, but the most common are age and extensive sun exposure. Further risk factors include having fair skin, having blue, green, or light-colored eyes, and being caucasian. Patients with a previous history of skin cancer are also at a higher risk. Understanding the signs and symptoms of ocular cancers is a crucial factor in the cancer’s treatment and resolution; treating ocular cancers early may save your vision and your life. Treatments for ocular melanoma include: surgery, watchful waiting, and radiation therapy.

Surgical method may vary depending on the type and severity of eye cancer present. Removal of the tumor and a small amount of the healthy tissue surrounding it is often performed in eye cancers which haven’t spread significantly. In larger, more aggressive tumors, unfortunately the eye is not able to be saved and aggressive surgical intervention is required; this can include either enucleation or exenteration. Enucleation removes the affected eye and part of the optic nerve; patients may be fitted for an artificial eye after this procedure. Exenteration removes the eye, the lid, muscles, nerves, and fat of the eye socket; patients may be fitted for a facial prosthesis or artificial eye after this procedure.


Retinoblastoma is an almost predominantly childhood cancer; it will usually occur in children younger than five and is a rapidly developing cancer affecting the retina. The most obvious sign of retinoblastoma is an abnormal pupil, often visibly noted as a “white eye” reflection. Children with retinoblastoma may also present with a strabismus (crossed eye), proptosis (bulging eye), and a red, irritated eye. Often, parents will note a defect in “red eye” noticed in photographs; an affected eye will continue to show a whitish appearance while an unaffected eye will react normally with a reddened appearance.

Caught early, retinoblastoma is highly treatable; treatments can include chemotherapy, radiation, and/or enucleation (removal) of the affected eye. Left untreated, retinoblastoma is vision and life-threatening. Almost all untreated patients die of intracranial extension and disseminated disease within two years.

While any type of cancer is serious and potentially deadly, cancers of the eye are, fortunately, relatively rare. Routine examinations with your eyecare professional and being an active part of monitoring changes in your vision and eye appearance are the best methods for continued eye health and early treatment if a concern is noted. If you suspect or are concerned about any of the above conditions, please make the earliest appointment with an eye care professional.