Symptoms of eye cancer vary depending on the type of cancer you have and where it's located.
If you have an intraocular cancer, such as ocular melanoma, you might not have any symptoms and it will be detected in a routine eye examination. This is why it's important to have an eye test every two years.
If you do have symptoms of eye cancer, they may include:
- partial or complete loss of vision
- seeing flashing lights or spots
- a dark spot on your iris that's growing
- a visible lump on your eyelid with crusting or bleeding
- a bulging eye
- watery eyes
- pain in or around your eye, although this is quite rare
These symptoms aren't always caused by eye cancer and could be caused by a number of other reasons, but if you have any of them, see your GP or optician.
Most children with retinoblastoma look well, but parents may notice a squint or an odd looking pupil that looks white. Their eye may also look red and inflamed.
Your GP or optician will ask about your symptoms and examine you. He or she may also ask you about your medical history.
If your GP or optician thinks that you have eye cancer he or she will refer you to an ophthalmologist (a doctor who specialises in eye health, including eye surgery). If your ophthalmologist suspects you have eye cancer, he or she may refer you to a specialist centre for eye cancer.
You may have the following tests to confirm the diagnosis.
- Eye examination – your doctor or optician will shine a light into your eye and look inside with special hand-held instruments. Your doctor may put drops into your eyes – this can affect your vision for a short while.
- Fluorescein angiography – your doctor will inject a dye into your arm which will travel through your bloodstream to the blood vessels in your eyes where it will show up on photographs so he or she can look at the blood vessels in your eyes.
- Ultrasound scan – you doctor will move a small ultrasound sensor over your closed eyelids or on the skin around your eye. An ultrasound uses sound waves to produce an image of the inside of your eye.
- CT or MRI scan – you may have one of these tests to check the muscle and tissues in and around your eye. A CT scan uses X-rays to make a three-dimensional image of your body. An MRI scan uses magnets and radiowaves to produce images of the inside of your body.
- Biopsy – using a fine needle, your doctor will take a sample of the fluid inside your eye or on the surface around your eye. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.
Your treatment will depend on the type of eye cancer you have, the size and how far it has spread (which is called staging) and your general state of health. There are three main treatments for eye cancer.
Surgery usually involves removing just the affected tissue. This is often enough to remove most eyelid tumours. However, you may need to have a small part of your eye, or if the cancer affects a large part of your eye, your whole eye removed (enucleation surgery). If you have your eye removed an artificial (prosthetic) eyeball can be created to match your remaining eye. This will last for your lifetime, you won’t need to have it replaced.
If the cancer has spread you may need to have your eye and eyelid, and the muscles, nerves, and fat in your eye socket removed (exenteration surgery). After this surgery you may have an artificial eye or a facial prosthesis fitted.
Some types of eye cancer, such as melanoma of the eye, can be treated with laser therapy (a high-energy beam of light will be used to destroy the cancer cells).
Surgery is sometimes combined with radiotherapy to treat eye cancer. Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. Radiotherapy can now be targeted to the area that needs treating to prevent damaging normal tissues close by. Alternatively a source of radioactive material will be put in or near your tumour. This is called brachytherapy.
Radiotherapy is often used to treat melanoma of the eye.
The length of your radiotherapy treatment will depend on what type of eye cancer you have and how severe it is. If you have ocular melanoma for example, you will usually have external beam radiotherapy as small doses over a few days, or brachytherapy for a week. Ask your doctor for information on the type and length of treatment you need.
Chemotherapy is a treatment to destroy cancer cells with medicines. They are usually injected into your vein but sometimes may be given as tablets.
Chemotherapy can be effective for treating lymphoma of the eye and retinoblastoma. It's only used for melanoma of the eye if other types of treatment haven't worked.
Help and support
Being diagnosed with cancer 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, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, this is called palliative care.
The exact reasons why you may develop eye cancer aren't fully understood at present. However, you may be more likely to develop certain types of eye cancer if you have:
- blue, grey or green eyes
- unusual brown spots on your eye
- lots of unusually shaped or large moles (atypical mole syndrome)
- been out in the sun too much without wearing sun protection, such as sunglasses or a wide-brimmed hat
- a weakened immune system – people who have HIV/AIDS or who are taking medicines that suppress their immune system are more likely to develop lymphoma of the eye
- inherited genes – four out of 10 children with retinoblastoma inherit a faulty gene from their parents
Can I drive if I lose an eye?
Often, yes, but it depends on your vision in the remaining eye. You will need to wait until you have adjusted to seeing with only one eye.
If you have had an eye removed, you will find it harder to tell how far away objects are from each other and from you. This can affect how safely you drive, but it doesn't always mean you have to give up driving. However, you do need to inform the Driver and Vehicle Licensing Agency (DVLA) and your car insurer that you have had an eye removed.
To drive legally, you need to meet the visual standards for driving set out by the DVLA. These include being able to read a number plate from a distance of 20.5m, and having an adequate field of vision. If you have only one eye, you need to have a full and unimpaired visual field in the remaining eye.
Your optician or ophthalmologist will be able to test whether you meet the DVLA's visual standards for driving.
It can take some time for you to adjust to having only one eye so that you can drive safely. Ask your doctor for advice on your progress and for information about available support.
Can my eye cancer be treated with laser surgery?
Yes, but it does depend on what type of cancer you have and how far it has spread.
Laser therapy uses a high-energy beam of light to destroy the cancer cells. Cancer cells are more susceptible to heat than normal cells. However, the laser may affect your vision.
Transpupillary thermotherapy is a form of laser treatment that uses a less powerful laser and is less likely to damage your vision. It can sometimes be used to treat small melanomas in the lining of the eye (choroidal melanomas). Before it’s carried out, an eye drop is used to dilate your pupil so that the laser can be safely directed onto the tumour. You usually need several transpupillary thermotherapy treatments.
Laser treatment is often combined with radiotherapy.
For more information about laser surgery, ask your doctor.
How will chemotherapy for eye cancer affect my life?
Chemotherapy can cause a range of side-effects, which can be difficult to cope with. Different people respond differently to chemotherapy, so it's hard to predict exactly how it will affect you.
Chemotherapy can cause a range of side-effects, which can be difficult to deal with.
Chemotherapy uses medicines to destroy cancer cells. There are lots of different types of chemotherapy medicines. Usually they are injected into a vein but sometimes you can take tablets.
Unfortunately, chemotherapy doesn't only target cancer cells – it can affect healthy cells too. This is what causes the side-effects.
Some potential side-effects from chemotherapy include:
- anaemia (a reduction in red blood cells)
- feeling sick
- a sore mouth or mouth ulcers
- getting infections more easily
- hair loss
For some people, the side-effects are minimal and have little effect on their daily life. For others, they can be very debilitating. Tiredness and fatigue can be a particular problem. If you're feeling tired when having chemotherapy, it's a good idea to slow down and rest more. You may not be able to do all the things you did before you started treatment.
The severity of the side-effects depends on the dose and length of your treatment. If you have high-dose chemotherapy over a period of several weeks or months, you’re likely to be most affected by side-effects.
Once you have completed your chemotherapy, your general health should improve and your hair will grow back.
Ask your doctor for more information about the side-effects of chemotherapy.
How will losing an eye affect me?
Psychologically, having one eye may take some time to get used to, but physically it may not have a huge impact on your life. You should be able to do most of the activities you did before the operation.
How much having your eye removed (enucleation) affects your life will depend to some extent on how much vision you had in the eye beforehand. If your vision was already poor because of the cancer, you may find it easier to adjust to having one eye. However, if you had full vision in the affected eye, it may take longer to come to terms with having it removed.
After having an eye removed, it can sometimes feel as if the eye is still there. And you may see things that aren't there. This is called having visual hallucinations. This is a normal reaction that happens because your brain is used to receiving signals from your eye. Over time, this will stop happening.
The biggest change to your vision will be in depth perception. This means that it will be difficult to tell how far away objects are from each other and from you. With time, you will adjust to this. For some people, losing an eye may affect their balance.
Common feelings after surgery include anger, depression and being worried about how other people view you. Talk to your loved ones about your feelings.
Also talk to your doctor and ask him or her to be honest with you about how your appearance may change as this will help you cope better. It may also be useful to talk to a counsellor or someone who has had a similar operation.
After the operation, take time off work to adjust to how you look before going back to everyday living. Wearing glasses or sunglasses will help to draw attention away from your eye until you're feeling more confident.
How will radiotherapy for eye cancer affect me?
Having radiotherapy for eye cancer can cause some side-effects. Most of these are short term and will go away soon after you stop your treatment. However, some side-effects may last longer or appear years after treatment.
Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour, or a source of radioactivity will be implanted in your eye (brachytherapy).
Unfortunately, the radiation can also damage nearby healthy cells. This is what causes side-effects. Temporary side-effects are listed below.
- Losing your eyelashes. These will grow back after you stop having radiotherapy.
- Swelling of your eye or around your eye. You will be offered eye drops or steroids to help control this.
- Tiredness. This may carry on for a while after you stop having radiotherapy.
Radiotherapy can sometimes cause long-term problems, such as those listed below.
- Reduced tear production. The radiation may damage your tear gland and you may need to use eye drops to prevent sore and dry eyes.
- Cataracts. The radiation can cause your eye lens to become cloudy and make it hard to see. This may happen years after having your treatment and you may need surgery to remove the cataracts
- Scarring. Radiation can cause scarring when used on skin or tissue.
- Loss of vision. Radiation can damage your optic nerve and impair your vision.
Ask your doctor for more information about the side-effects of radiotherapy.
Will eye surgery for eye cancer change how I look?
How much eye surgery will affect your appearance depends on the type of surgery you have.
Surgery for treating eye cancer can range from removing just the tumour, removing part of your eye such as the iris, to removing your whole eye, which is called enucleation. Surgery may also be used to remove a tumour in the area around your eye, most commonly from your eyelids (extraocular cancer).
Extraocular surgery usually requires your surgeon to remove some tissue that surrounds your eye. The amount of tissue your surgeon will remove depends on how far the cancer has spread. Advances in surgery and reconstruction mean that scarring is often less of a problem than it used to be. Over time, some scars can fade and become less noticeable.
If some, or part of your iris needs to be removed, you can wear cosmetic contact lenses to give your eyes a more natural appearance.
If your surgeon has to remove your whole eye, he or she will fit an artificial eye. Advances in eye prosthetics and eye implants (which help maintain the structure of the socket) mean that you can often move an artificial eye to some degree, and they can look very natural.
If you need to have your eye and eyelid, and the muscles, nerves, and fat in your eye socket removed in exenteration surgery, you may have an artificial eye or a facial prosthesis fitted.
Ask your doctor for more information on your treatment options and how they will affect your appearance.
- Eye cancer. CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 23 June 2010
- Melanoma of the eye (ocular melanoma). Macmillan Cancer Support. www.macmillan.org.uk, published 1 December 2010
- Eye cancer (retinoblastoma). CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 28 September 2009
- Basal cell carcinoma. eMedicine. www.emedicine.medscape.com, published 15 November 2011
- The skin. CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 23 May 2011
- Head and neck cutaneous squamous cell carcinoma. eMedicine. www.emedicine.medscape.com, published 7 July 2011
- Ocular lymphoma. eMedicine. www.emedicine.medscape.com, published 2 May 2011
- 10 reasons for having an eye examination. The College of Optometrists. www.college-optometrists.org, accessed 24 November 2011
- General information about intraocular (eye) melanoma. National Cancer Institute. www.cancer.gov, published 15 June 2010
- Treatment option overview. National Cancer Institute. www.cancer.gov, published 15 June 2010
- How chemotherapy works. CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 17 August 2011
- Eye cancer (melanoma and lymphoma). American Cancer Society. www.cancer.org, published 27 June 2011
- Eye cancer. Cancer.net. www.cancer.net, published 3 August 2011
- For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency, August 2011. www.dft.gov.uk
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