Eye cancer

Eye cancer is caused by an abnormal and uncontrolled growth of cells in or around your eye. There are many different types of eye cancer. Sometimes the cancer develops in your eye, but cancers can also spread to your eye from other parts of your body. 

About eye cancer

Eye cancers are rare. The most common type is called uveal melanoma. 

If you have eye cancer, your tests and treatment will depend upon what type you have. We have some general information about eye cancer here, but your doctor will be able to discuss what’s best for you in your circumstances.

Some rare types affect very young children, but it’s mostly adults who get eye cancer. You’re most likely to be diagnosed with eye cancer if you are over 75.

Types of eye cancer

There are lots of different types of eye cancer, each affecting different parts of the eye. 

• Uveal melanoma. This type of eye cancer starts in the pigmented cells (melanocytes) deep in the eye. These parts of the eye are collectively known as the uveal tract and include the iris, ciliary body and choroid. The choroid is a layer under the retina that is most commonly affected, and these types of eye cancer are called choroidal melanomas.  
• Conjunctival melanoma. This type of cancer also starts in pigmented cells called melanocytes, but it affects the conjunctiva. This is the thin membrane that covers the white of the eye and inside of the eyelids.
• Ocular lymphoma. This type of cancer starts in part of your immune system, called the lymphatic system, and then affects your eye. 
• Retinoblastoma. This is the most common eye cancer in children. It usually affects children under three and can affect one or both eyes. It develops in the retina, which is at the back inner surface of the eye. It often shows up as an unusually white pupil reflex, particularly in photographs.
• Lacrimal gland cancer starts in the part of your eye that makes tears.

Cancer can also affect the skin or structures around your eye, such as your eyelid or the lacrimal gland which makes tears.

Eye cancer can also develop after spreading from tumours elsewhere in the body. These tumours are called secondary cancers. In women, secondary eye cancers are most often spread from breast tumours, and in men they most often spread from lung tumours.

Symptoms of eye cancer

Symptoms of eye cancer vary, depending on the type of cancer you have and where it is located. Most of the time, cancers inside the eye cause no symptoms at all and they are usually picked up during a routine eye test.

If you notice the following symptoms, you should book an appointment with an optician for a check-up: 

• a change in your vision
• a change to the way your eye looks, such as a growing dark spot on the white of the eye (iris)

If your child has retinoblastoma, you may notice that one pupil looks white instead of red, particularly when you take a photograph using a flash. They may also develop a squint, which means that their eyes are not aligned, with one eye looking in a different direction from the other. Squints are not usually caused by retinoblastoma, but if you notice any of these signs then make an appointment with your optician or doctor.

Diagnosis of eye cancer

If your optician or doctor thinks that you may have cancer within your eyeball, they’ll refer you to an ophthalmologist for tests. This is a doctor who specialises in eye health, including eye surgery. The ophthalmologist may then refer you to a specialist centre for treatment.

You might have the following tests to confirm whether you have eye cancer.

• Eye examination, including photographs of the inside of your eye.
• . Your doctor will move a small ultrasound sensor over your closed eyelids.
• Optical coherence tomography (OCT) scan. This uses laser light to look at the inside of your eye and produces an image of it. It’s painless and takes only a few minutes.
• Fluorescein angiogram. This is where you have dye put into your vein, which travels through your body to the blood vessels in your eyes. An image taken afterwards will clearly show the inside of your eye.
• Biopsy. Using a fine needle, your doctor will take a sample of tissue or fluid which will be sent to a laboratory for testing.

If your doctor thinks you might have skin cancer around your eye, they may refer you to a specialist. This may be an ophthalmologist (a doctor specialising in eye conditions), a plastic surgeon or a dermatologist (a doctor specialising in skin conditions).

Treatment of eye cancer

Your treatment will depend on the type of eye cancer you have, how big it is, whether it’s spread, and your general health. Treating eye cancer is a specialist area, so we’ve only given an overview here. Your doctor will explain your treatment options in more detail to help you make a choice.

There are two main treatments for eye cancer – radiotherapy and surgery.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. It’s sometimes used on its own to treat eye cancer and sometimes it’s used with surgery. There are three main types:

• brachytherapy – this is where a radioactive plaque is surgically placed on the surface of the eye to treat the tumour and removed after a few days
• proton beam radiotherapy – this is a high dose of targeted proton radiation beams
• stereotactic radiotherapy – this uses many small high dose radiation beams focused onto a small area

Radiotherapy can damage healthy cells as well as cancerous cells and that can sometimes lead to side-effects. These include cataracts, an inflamed and painful cornea (keratitis) and damage to the retina which can affect your sight. Talk to your doctor or nurse about the different types of radiotherapy and what might be best for you.

Surgery

Having surgery means having cancerous tissue removed. Depending on how big the tumour is and where it is, might mean having the tumour removed, or part or all of the eye. Removing the whole eye is called enucleation and it’s usually only done if the tumour is large.

If the whole eye is removed, your surgeon will take out the eyeball and put an eye-shaped implant into the socket. Your eye muscles are attached to the implant so that it moves like an eye. A few weeks afterwards you’ll have an artificial eye put over the implant which matches your eye closely. It should move and look natural.

Other treatments

Some types of eye cancer, such as small melanomas of the eye, can be treated with special laser therapy. There are two main types called transpupillary thermotherapy (TTT) and photodynamic therapy. TTT uses an infrared laser to destroy the tumour using heat. It’s sometimes used alongside radiotherapy. Photodynamic therapy uses a light-sensitive drug and a laser or other light sources to destroy cancer cells.

Chemotherapy  is a treatment to destroy cancer cells with medicines. These can be used for secondary eye cancers or for eye cancers that have spread elsewhere in the body.

Causes of eye cancer

The most common type of eye cancer in adults is eye melanoma. Doctors don’t yet fully understand why people develop it, but there are several things that make it more likely.

• Having eyes that are a light colour – blue, grey or green.
• Your age – most people who get eye cancer are around 70.
• If you are white, with fair skin.
• If you have lots of unusually shaped or large moles.
• If you have coloured growths called eye naevi (‘eye freckles’). These may be a choroidal naevus – pigmented lesions that can only be seen during an eye exam – or another type that is visible on the outside of the eye.

Retinoblastoma may be caused by a faulty gene. Around one in 10 children with it will have a parent or close family member with the condition.

Help and support

Being diagnosed with cancer and facing treatment can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need. Talk to your doctor or nurse if you would like support or you’re finding it hard to cope. There are support and information organisations for people with cancer listed in the helpful website section.