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In the United States, there were an estimated nearly 3,500 new cases of cancers of the eye in 2020. Vision and eye changes can be signs of eye cancer, including floaters, blurry vision, shadows, loss of vision, and lumps in the eye.
There are three main forms of cancer that impact the eye: melanoma, lymphoma, and retinoblastoma.
The most common form of eye cancer in adults in melanoma. Melanoma most often begins in the skin, but it can start in the uvea or conjunctiva of the eye.
Melanoma treatment depends on your health and the size of the melanoma. It typically consists of either radiation or surgery.
Intraocular lymphoma is a rare form of cancer developing in the retina and/or vitreous fluid of the eye. A biopsy is usually needed to diagnose eye lymphoma.
Retinoblastoma is commonly a childhood cancer that starts in the retina. The goal of treating retinoblastoma is to preserve vision.
Symptoms of Eye Cancer
Cancer that begins in the eye is called intraocular cancer. It is not common.
Often, eye cancer is not detectable, as it may not cause issues that you will notice in its early stages. Many times, eye cancer symptoms can mimic those of other eye conditions. Eye cancer can be caught through regular eye and vision screenings, making it incredibly important to keep up with routine eye care.
Some potential signs of eye cancer include:
- Floaters or wiggly lines in your field of vision.
- Shadows or flashes of light.
- Loss of vision.
- A spreading dark patch in your eye.
- Dark spot on the iris.
- Lump in the eye or on your eyelid.
- Bulging of one eye.
- Pain in your eye, though this is not common.
If you notice any changes in your vision or eye, contact your eye doctor for a comprehensive exam. Keep up with routine eye care appointments as well.
Types of Eye Cancer
The most common forms of eye cancer in adults are melanoma and lymphoma. Retinoblastoma is the most common form of eye cancer in children.
Ocular melanoma is a type of cancer that forms in the cells of your eye that give it its color- pigment cells. This form of cancer most commonly develops in the middle layer of your eye, called the uvea. It can also form in the conjunctiva. Even though it is the most common form of intraocular cancer in adults, it is still very rare.
Lymphoma can develop in the vitreous and retina of the eye. Primary intraocular lymphoma (PIOL) is typically a non-Hodgkin’s B-cell lymphoma that often impacts people with compromised immune systems.
Retinoblastoma also begins in the retina at the back of the eye. It most commonly impacts children, although adults can have this form of eye cancer too. Genetics usually play a role in the formation of retinoblastoma.
Intraocular melanoma impacts around 2,500 people per year in the United States, making it the most common form of eye cancer, although it is still fairly rare.
Tumors generally form in the uveal tract, most often in the choroid, which is the blood-vessel-filled tissue layer. Melanoma can also form in the iris of the eye. These tumors are often visible more quickly and therefore have a good prognosis.
Melanoma is most commonly associated with cancer of the skin due to exposure to the sun. Unlike typical melanoma, most ocular melanoma does not necessary develop because of sun exposure. Conjunctival melanoma, however, can form with extended exposure to UV light since it affects the outer surface of the eye, the conjunctiva.
Risk factors for developing ocular melanoma include:
- Older age.
- Having light-colored eyes like blue or green.
- Having light-colored skin.
- Abnormal skin pigmentation.
- Moles in or on the eye, or skin conditions that cause abnormal moles.
Ocular melanoma can develop due to a genetic condition; however, it is not considered a heritable condition. Ocular melanoma occurs as errors in pigment cells multiply too rapidly, causing mutations leading to a tumor.
There are not many noticeable symptoms of ocular melanoma, so it is usually detected in a routine eye exam. It will be definitively diagnosed through a dilated eye exam.
Treatment of melanoma will depend on where the tumor is located and how big it is. The main goal of treatment is to try and preserve your eye.
Treatment options include:
Brachytherapy.Small plates are placed near the tumor and left there for up to a week to kill the cancerous cells using plaques, which are made up of radioactive material.
Surgery.When the tumor is small and you can still see, surgery can remove it.
External radiotherapy.Beams of radiation target the cancerous cells, directed by a machine.
Enucleation.This is a last-resort option that involves removal of the eye. It is only done if the tumor is too big and you have lost vision as a result.
Chemotherapy, a common cancer treatment, is not regularly used to treat intraocular melanoma.
The prognosis with treatment depends on the size and location of the tumor, the parts of the eye that are impacted, and the time of diagnosis. With a diagnosis of small intraocular melanoma, the majority of people (80 percent) will live at least five more years.
Understanding Intraocular Lymphoma
This is a form of cancer that involves the white blood cells, which are a big part of your body’s immune system response. Lymphoma often occurs in people who have immune system deficiencies, those who are elderly, or those who have conditions or diseases that impact the immune system.
With primary intraocular lymphoma (PIOL), most people (8 out of 10) will get it in both eyes. The majority will also have primary nervous system lymphoma, and the brain will be affected as well.
Lymphoma of the eye most commonly affects the elderly, with the median age being 50 to 60. The cancer often either spreads to the brain and/or central nervous system, or it is already there. Intraocular lymphoma is most commonly B-cell non-Hodgkin’s lymphoma, but T-cell lymphomas are possible as well.
Diagnosing & Treating Ocular Lymphoma
To diagnose intraocular lymphoma, a biopsy is typically necessary. Your ophthalmologist can do a procedure called vitrectomy where they take a small amount of your vitreous fluid to sample and test for presence of the cancer. Imaging can also be done to get a good look at your eye and the tumor’s progression.
External radiation therapy, chemotherapy, or a combination is used to treat intraocular lymphoma. External radiation uses targeted beams of high energy to shrink the tumor and kill cancerous cells.
Chemotherapy is the use of medication to kill cancerous cells. When intraocular lymphoma is in only one eye, local chemotherapy applied directly to that eye in the form of methotrexate or rituximab is highly effective.
Intravenous chemotherapy is widely used when lymphoma impacts the central nervous system as well as the eye. Typically, the medication methotrexate is used.
Retinoblastoma in Children
Retinoblastoma is a form of eye cancer that begins in the retina at the back of the eye. It is often the result of a genetic mutation of the RB1 gene.
Retinoblastoma is hereditary. It is curable if caught and diagnosed early, before it spreads beyond the eye.
When inherited, retinoblastoma typically presents early in childhood and regularly affects both eyes. Retinoblastoma most often forms in children younger than 2 years old, although it can present at any age.
Retinoblastoma forms in both eyes about one-third of the time. It often presents as a white spot in the pupil of the eye and/or crossed eyes. It can spread to the rest of the body, and in its advanced form, it can be life-threatening.
Retinoblastoma is diagnosed through a comprehensive medical exam that can also include imaging to check for the cancer’s potential spread.
As many as 90 percent of children with retinoblastoma are successfully treated. Treatment outcomes are better when the cancer has not spread beyond the eye.
During the consultation, we will ask you about your eye health history and your medications, and perform some tests. You will then be examined by the surgeon who will discuss your treatment options. Your personal Patient Counselor will help you throughout the process.
Your Counselor can review payment options and schedule you for surgery and related appointments, such as pre- and post-operative exams. Prior to your procedure you will have a dilated eye exam, and you should discontinue wearing your contact lenses and begin taking eye drops as instructed.
Plan to be at the center for two to three hours the day of your procedure. ICL eye surgery is a fairly brief outpatient procedure. Your surgeon dilates your eyes, and gives you a local anesthetic to numb the area. A tiny incision is made, and the clear lens is slipped between your iris and your eye’s natural lens. The day of your procedure should be a day of rest.
Your Patient Counselor will give you detailed post-operative instructions and eye drop regimen for your recovery. After ICL surgery, you’ll need several follow-ups with your eye doctor. Visual recovery is rapid, and you can expect noticeable improvement within a day or two. Most patients are generally able to return to their normal activities within two or three days following their procedure.
Treatment Options for Retinoblastoma
Treatment for retinoblastoma depends on whether or not the cancer has spread past the eye to other parts of the body, the location and size of the tumor, how it has impacted vision, and whether or not the cancer is in both eyes or just one. The main goals of treatment are to remove the cancer, enhance survival, save the eye, limit future side effects, and preserve as much vision as possible.
There are several options when it comes to treating retinoblastoma, such as:
- Radiation therapy. A machine directs beams of energy at the tumor cells to shrink them and kill the cancer.
- Chemotherapy. Medication is used to shrink the tumor. It can be local in the eye or systemic throughout the entire body.
- Cryotherapy. This is a method of freezing cancer cells using an extremely cold substance, such as liquid nitrogen, to freeze, thaw, and kill cancer cells.
- Thermotherapy. This treatment uses targeted, extreme heat to kill cancer cells.
- Laser therapy. Lasers can be used to damage the blood vessels that are providing nutrients to the tumor, in order to kill cancer cells.
- Surgery. When the tumor has grown too large, enucleation surgery will remove the eyeball completely. This will keep the cancer from spreading to other parts of the body.
The child’s doctor and medical team will decide on the best course of treatment that will offer the highest odds for successfully eradicating the cancer. Often, a combination of treatment methods is used.
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