Eye cancer

Published by Bupa's Health Information Team, March 2010.

This factsheet is for people who have eye cancer, or who would like information about it.

Cancer of the eye is rare in the UK. About 450 people get eye cancer each year. Eye cancer is usually treated with surgery, radiotherapy or chemotherapy.

How cancer develops

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About eye cancer

Eye cancer is caused by an uncontrolled growth of cells in or around the eye. There are several different types of eye cancer.

Cancer that develops in the eye is called intraocular cancer. Cancer that develops outside the eye is called extraocular cancer.

Intraocular eye cancers

• Non-Hodgkin's lymphoma - this usually develops in lymph nodes (these are glands throughout the body that are part of the immune system). However, non-Hodgkin's lymphoma sometimes develops in the eye.
• Ocular melanoma - this usually develops in the lining of the eyeball, the muscles that focus the eye, the iris (the coloured part of the eye) or the inner surface of eyelids (conjunctiva). Melanoma is one of the most common types of intraocular eye cancers.
• Retinoblastoma - this usually develops in the retina and can affect one or both eyes. It is often inherited and develops in young children, usually under five. Over nine out of 10 children with retinoblastoma are cured with the right treatment.

Extraocular eye cancers

• Basal cell carcinoma - this is the most common type of skin cancer in the UK. It often develops near your eye, especially on the lower eyelid. It causes a small red growth on the skin that often has a rolled edge to it. It doesn't usually spread to other parts of the body, but it can affect surrounding tissue if it isn't treated.
• Squamous cell carcinoma - this usually develops on the surface of the eyelid.
• Rhabdomyosarcoma - this is a very rare type of eye cancer which develops in the muscles that move the eye. It mostly affects children.
• Optic nerve tumours - rarely, a tumour can develop in your optic nerve which connects your eye to the brain.

Secondary eye cancers

Sometimes a cancer can spread to the eye from another part of the body (called a secondary eye cancer). This is most likely to happen in women with breast cancer, and in men with lung cancer.

Symptoms of eye cancer

Symptoms of eye cancer vary depending on the type of cancer and where it's located.

Intraocular cancers such as ocular melanoma have no symptoms but are usually detected in routine eye examinations. This is why it's important to have an eye test every two years.

Some eye cancers can cause symptoms including:

• 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
• pain in or around the eye (rare)
• a bulging eye
• watery eyes

Most children with retinoblastoma look well, but parents may notice a squint or an odd looking pupil. The pupil may be white in flash photography rather than showing a red eye.

Causes of eye cancer

Doctors don't fully understand why eye cancer develops. 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 the immune system, are more likely to develop lymphoma of the eye
• inherited genes - four in 10 children with retinoblastoma inherit a faulty gene from their parents

Diagnosis of eye cancer

If your GP thinks that you have cancer of the eye, you will usually be referred to your local hospital to be seen by a doctor who specialises in eye conditions (an ophthalmologist). If the 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 diagnosis.

• Eye examination - your doctor will shine a light into your eye and look inside the eye using special hand-held instruments. You may have drops put into your eyes which can affect your vision for a short while.
• Fluorescein angiography - a dye is injected into your arm which travels through your bloodstream to the blood vessels in the eyes where it shows up on photographs so your doctor can look at the blood vessels in your eyes.
• Ultrasound scan - a small ultrasound sensor is moved over closed eyelids or on the skin around your eye with sound waves creating an image of the inside of your eye.
• CT or MRI scan - these may be done to check the muscle and tissues in and around your eye.
• Biopsy - using a fine needle, a sample of the fluid inside your eye is taken (or, for suspected cancer on the surface around your eye, a sample of tissue is taken) and sent to a laboratory for diagnosis.

Treatment of eye cancer

Treatment depends on the type of eye cancer, the size and how far it has spread (staging) and your general state of health. There are three main treatments for eye cancer.

Surgery

Surgery involves removing just the affected tissue. Surgery is usually enough to remove most tumours of the eyelids. It's sometimes combined with radiotherapy for treating cancers in the eye.

Some types of eye cancer, such as melanoma of the eye, can be treated with laser therapy (a high-energy beam of light is used to destroy the cancer cells).

Occasionally, if the cancer affects a large part of the eye, the whole eyeball may need to be removed (enucleation). You may feel upset or worried about how you will cope. The doctors and nurses looking after you will support and help you. An artificial (prosthetic) eyeball can be created to match your remaining eye.

Non-surgical treatments

• Radiotherapy - radiation is used to kill cancer cells. It is often used for treating melanoma of the eye.
• Chemotherapy - anti-cancer drugs are used to destroy cancer cells. They are usually injected into a 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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.