Eye cancer (ocular cancer) is relatively rare in the UK, with around 750 cases diagnosed each year.

Melanoma is the most common type of eye cancer. About a quarter of all people diagnosed with eye cancer in the UK are aged 75 and over. The exception to this is a type called retinoblastoma. This usually affects children under the age of 5.

 

There are a number of different types of cancer that affect the eyes. These include: eye melanoma; squamous cell carcinoma; lymphoma; retinoblastoma which is a childhood cancer. Cancer can also sometimes develop in the tissues surrounding your eyeball or spread to the eye from other parts of the body, such as the lungs or breasts.

 

Eye cancer does not always cause obvious symptoms and may only be picked up during a routine eye test.

However some symptoms can include:

  • shadows
  • flashes of light or wiggly lines in your vision
  • blurred vision
  • a dark patch in your eye that's getting bigger
  • partial or total loss of vision
  • bulging of one eye
  • a lump on your eyelid or in your eye that's increasing in size
  • pain in or around your eye, although this is rare  

These symptoms can also be caused by more minor eye conditions, so they're not necessarily a sign of cancer. But it's important to get the symptoms checked by a doctor as soon as possible.

 

Eye melanoma, the most common type of eye cancer, occurs when the pigment-producing cells in the eyes divide and multiply too rapidly. This produces a lump of tissue known as a tumour. It's not clear exactly why this occurs, but the following factors may increase the risk of it happening:

Eye melanoma is slightly more common in men than in women and is more common in older people. People with light coloured eyes are more likely to develop melanoma of the eye than are people with brown eyes. In addition eye melanoma is slightly more common in men than in women. People with some inherited conditions can also be more likely to develop some types of eye cancers.

 

You might have several tests. These help the doctor decide whether you have eye cancer and if so, the best treatment for you.

The eye specialist (ophthalmologist) will examine your eyes with a number of different instruments. They will look at the different structures of your eye to check for abnormalities.

You would usually have an ultrasound scan of your eye to build up a picture of the inside of your eye.

Your doctor may take pictures of a suspected cancer with a special camera.  A fluorescein angiogram takes pictures the back of the eye. It looks at the blood vessels using a type of dye.

Colour fundus photography is often used at the same time as fluorescein angiography. This takes pictures of the inside surface of the eye, and can pick up changes including eye cancer. It keeps a record of these changes during and after treatment.

Your doctor might take a sample of cells or fluid from your eye. This is called a fine needle aspiration biopsy.

Another biopsy called a vitreous biopsy tests for conditions of the eye including lymphoma.

You would usually have blood tests to check your general health and see how well your liver and kidneys.

You might have other scans such as an MRI scan or a CT scan. These scans help the doctor to find out whether the cancer has spread outside of the eye, to nearby lymph nodes or elsewhere in the body.

You might also have some other tests if your doctor thinks that you might have lymphoma of the eye such as a PET-CT scan. This is a combination of a PET scan and a CT scan.

Your doctor may also suggest that you have a lumbar puncture and you may have a bone marrow test to check for any lymphoma that may have spread to your bone marrow.

 

Treatment depends on the size and location of the tumour and any treatment will aim to conserve the affected eye whenever possible.

The main treatments for eye melanoma are: brachytherapy – this is where tiny plates lined with radioactive material called plaques are inserted near the tumour and left in place for up to a week to kill the cancerous cells;  external radiotherapy – this is where a machine is used to carefully aim beams of radiation at the tumour to kill the cancerous cells; surgery to remove the tumour or part of the eye; removal of the eye – this may be necessary if the tumour is large or you have lost your vision.

Chemotherapy is rarely used for eye melanoma, but may be suitable for other types of eye cancer.

If you are diagnosed with eye melanoma, your surgeon may ask a pathologist to examine the tumour after your operation. They look for abnormalities of the chromosomes in the tumour cells. It helps give doctors information about the chances of your cancer coming back or spreading.