Eye cancer

Eye cancer starts in or around your eye. It’s caused by an abnormal and uncontrolled growth of cells. There are many different types of eye cancer, depending on which cells are affected. Cancers can also spread to your eye from other parts of your body.

Types of eye cancer

Cancer that starts in your eye is called primary eye cancer. There are many different types of primary eye cancer. Each type affects different parts of the eye.

Uveal melanoma

This is the most common eye cancer diagnosed in adults. It starts in pigmented cells (melanocytes) in a part of the eye called the uveal tract. This tract includes:

• the iris
• the muscle behind the iris, called the ciliary body
• a layer under the retina, called the choroid

Uveal melanomas that develop in the choroid are also called choroidal melanomas.

Conjunctival melanoma

This type of cancer also starts in pigmented cells called melanocytes. But it develops in the covering of the eye (conjunctiva). This thin membrane covers the white of the eye and the inside of the eyelids.

Ocular lymphoma

This type of cancer starts in part of your immune system (the lymphatic system) in your eye.

Retinoblastoma

This is the most common eye cancer in children. It’s usually diagnosed in children under three and can affect one or both eyes. This type of eye cancer starts in the retina. This is the back inner surface of the eye. Retinoblastoma often shows up as an unusual white reflection from the pupil, particularly in photographs.

Other types of eye cancer

Eye cancer can start in the skin, muscles or nerves around your eye. It may start:

• around your eyeball – called orbital cancer
• in your eyelid – such as basal cell carcinoma
• in the lacrimal glands –glands which make tears

Cancer can also spread to your eye from a cancer elsewhere in your body. These are called secondary cancers.

• In women, secondary cancers in the eye have most often spread from breast tumours.
• In men, secondary eye cancers have usually spread from lung tumours.

Causes of eye cancer

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

• having light-coloured eyes – blue, grey or green
• age – although still rare, eye melanoma becomes more common with age
• being white or having fair skin
• having lots of unusually shaped or large moles
• having coloured growths called eye naevi (‘eye freckles’) – sometimes these can be seen on the outside of the eye but some can only be seen during an eye exam

Retinoblastoma is the most common eye cancer in children and is caused by a faulty gene. But this is not usually inherited – it develops spontaneously in most cases. Only around one in 10 children diagnosed have a history of retinoblastoma in the family.

Symptoms of eye cancer

Eye cancer symptoms vary, depending on the type you have and where it is. Most of the time, cancers inside the eye cause no symptoms. They are often 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 such as blurring or not being able to see so well
• a lump on your eyelid that doesn’t go away
• any change to the way your eye looks – for example, a growing dark spot on the coloured part of your eye (the 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. If you notice this, contact your GP because your child needs to see a specialist. Your child may also develop a squint. This means their eyes are looking in different directions to each other. Squints aren’t usually caused by retinoblastoma. But if you notice this, make an appointment with your optician or GP.

Diagnosis of eye cancer

If your optician or GP thinks 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 refer you to a specialist centre for treatment.

You might have the following tests to determine if you have eye cancer.

• Eye examination, including photographs of the inside of your eye.
• Ultrasound scan. The doctor moves a small ultrasound sensor over your closed eyelids.
• Optical coherence tomography (OCT) scan. This painless scan uses light waves to measure the thickness of your retina.
• Fluorescein angiogram. You have an injection of a dye into a vein in your arm. It travels to the blood vessels in your eyes and makes them show up clearly on a scan.
• Biopsy. The doctor takes a sample of tissue or fluid with a fine needle. It’s then sent to a laboratory for testing.

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

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. You may be worried about how you’ll look after eye cancer surgery. Many people find it takes some time to adjust to this. Have a chat with your doctor about how your treatment will affect your appearance.

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. Specialist eye cancer clinics can supply information about support services for people with eye cancer. Patient organisations and voluntary groups for people with cancer can also be a great source of information and support.