Eye cancer
Your health expert: Professor Simon Taylor, Consultant Ophthalmic Surgeon
Content editor review by Liz Woolf, February 2023
Next review due February 2026
Cancer is an abnormal and uncontrolled growth of cells. Sometimes cancer starts in or around your eye. There are many different types of eye cancer, depending on the cells affected. Cancers can also spread to your eye from other parts of your body.
How cancer develops
Cancer explained | Watch in 1:48 minutes
In this video, we explain how, when cells divide uncontrollably, this leads to cancer.
About eye cancer
Eye cancers are rare. The most common type is called uveal melanoma.
In the UK, around one in every 80,000 people gets eye cancer each year. Some very rare types affect very young children, but it’s mostly diagnosed in adults. It’s most common in people aged between 85 and 89.
We can only give general information about eye cancer here. Tests and treatment depend on the type of eye cancer you have. Your doctor will discuss with you what’s best in your circumstances.
Types of eye cancer
There are many different types of eye cancer, each affecting 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 most often develop in the choroid. These types of eye cancer are also called choroidal melanomas.
Conjunctival melanoma
This type of cancer also starts in pigmented cells called melanocytes, but 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) within 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. It develops in the retina. This is the back inner surface of the eye. It often shows up as an unusually white reflection from the pupil, particularly in photographs.
Other types of eye cancer
Cancer can start in the skin or structures around your eye. For example, it may start in your eyelid or in the lacrimal glands, which make tears. There is a lacrimal gland above the outer corner of each eye.
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, and in men from lung tumours.
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 eye melanoma, but there are several things that make it more likely:
- 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 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
The symptoms of eye cancer 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
- 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. They may also develop a squint. This means they have one eye looking in a different direction from the other.
Squints are not 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).
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Treatment of eye cancer
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. Treatment depends on:
- the type of eye cancer you have
- how big it is
- if it’s spread
- your general health.
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 with surgery. There are three main types:
- brachytherapy – 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 – a high dose of targeted proton radiation beams
- stereotactic radiotherapy – many small high-dose radiation beams focused on a small area from different directions
Radiotherapy can damage healthy 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
Your surgeon will remove the cancer alone or with part of or all the eye. This depends on how big the tumour is and where it is. Removing the whole eye is called enucleation. Your surgeon will only do this if the tumour is large.
After surgery
You may have some bruising and swelling for a few days after your operation. Some people decide to wait for a while before they look at the changes after surgery. Your surgeon will try to hide any scars in existing lines and creases. Over time, scars usually fade and become less noticeable. You can use make-up or sunglasses to cover scars during the first few weeks after surgery.
If your eye is removed, your surgeon will put a permanent eye-shaped implant into the socket during the operation. For the next few weeks, you may wear a plastic shell over this implant. It’s the shape of a contact lens but larger. A few weeks afterwards, this shell is replaced with the artificial eye. It’s usually very hard for people to tell you have an artificial eye. It will have been made to match your real eye closely and should move almost normally, so it looks natural.
Living with one eye
Having one eye may take some time to get used to – both physically and emotionally. You might find that losing an eye affects your confidence, how you feel about yourself and your relationships too. It can take time to get used to these changes.
It’s harder to judge distance with one eye and you’ll need to turn your head to the left or right to see fully. But, once you get used to the artificial eye, you should be able to live life as you did before. You should leave your eye in when you sleep. You should also be able to do activities such as swimming and playing sport, and wear make-up.
It can take a few months for your vision to adjust to having one eye. If you drive, your doctor or optician will have to test your eyesight to see if you meet driving vision standards and are safe to drive. Car drivers don’t need to tell the Driver Vehicle Licensing Agency (DVLA) about losing sight in one eye. But if you have a bus, coach or lorry licence, you must tell the DVLA.
After having an eye removed, it can sometimes feel as if the eye is still there. You may see things that aren’t there (visual hallucinations). This can be unsettling but it’s normal. It’s your brain adjusting to your eye not being there, and over time the hallucinations should stop.
Other treatments
Chemotherapy is a treatment to destroy cancer cells with medicines. You may have chemotherapy to treat a lymphoma of the eye or retinoblastoma.
For melanoma that has spread, you may have immunotherapy. These medicines help your immune system to find and kill cancer cells.
You may have laser treatment for small retinoblastomas or small melanomas of the eye. These use heat to destroy the cancer.
You may have photodynamic therapy (PDT) for a particular type of small melanoma or a skin cancer around the eye. This uses a light-sensitive drug and a laser or other light source to destroy cancer cells.
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 feel concerned about the way you’ll look after eye cancer surgery. Many people find it takes some time to adjust. Have a chat with your doctor about how 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. Our helpful website section lists support and information organisations for people with cancer.
How you look after surgery will depend on the type of surgery you need. You may have some bruising and swelling for a few days after surgery. If there are any scars, your surgeon will try to hide them in existing creases.
If you have an eye removed, it’s likely to be less noticeable than you fear once you have your artificial eye. See our section on treating eye cancer for more information.
Sight changes can affect certain tasks. It’s harder to judge distance with one eye and you’ll need to turn your head to the left or right to see fully. But, once you get used to an artificial eye, you should be able to live life as you did before. See our section on treating eye cancer for more information.
The commonest type of eye cancer – melanoma – isn’t usually treated with chemotherapy. But you may have chemotherapy for a retinoblastoma or lymphoma of the eye. See our section on treating eye cancer for more information.
Eye cancer often doesn’t have any obvious signs and may be picked up during a routine eye examination. Some types of eye cancer cause your eyes to reflect white instead of red in photos. If you notice that, you should speak to a doctor or optician. There is more information in our eye cancer symptoms section.
Radiotherapy
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