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Eye Tumors

Introduction

Tumors inside of the eye, referred to as intraocular tumors, are composed of cells that grow abnormally and create a mass. There are many types of eye tumors. Eye tumors can be benign or malignant. Your doctor can detect an intraocular tumor with a thorough eye examination. Treatments vary depending on the type, location, size, and extent of the tumor.

Anatomy

Your eyes and brain work together with amazing efficiency. Light rays enter the front of your eye and are interpreted by your brain as images. Light rays first enter your eye through the cornea, the “window” of your eye. The cornea is a clear dome that helps your eyes focus.

The anterior chamber is located behind the cornea and in front of the iris. The anterior chamber is filled with a fluid that maintains eye pressure, nourishes the eye, and keeps it healthy. The iris is the colored part of your eye. Eye color varies from person to person and includes shades of blue, green, brown, and hazel. The iris contains two sets of muscles. The muscles work to make the pupil of your eye larger or smaller. The pupil is the black circle in the center of your iris. It changes size to allow more or less light to enter your eye.

After light comes through the pupil, it enters the lens. The lens is a clear curved disc. Muscles adjust the curve in the lens to focus clear images on the retina. The retina is located at the back of your eye.

Your inner eye, or the space between the posterior chamber behind the lens and the retina is the vitreous body. It is filled with a clear gel substance that gives the eye its shape. Light rays pass through the gel on their way from the lens to the retina.

The retina is a thin tissue layer that contains millions of nerve cells. The nerve cells are sensitive to light. Cones and rods are specialized receptor cells. Cones are specialized for color vision and detailed vision, such as for reading or identifying distant objects. Cones work best with bright light. The greatest concentration of cones is found in the macula and fovea at the center of the retina. The macula is the center of visual attention. The fovea is the site of visual acuity or best visual sharpness. Rods are are located throughout the rest of the retina.

Your eyes contain more rods than cones. Rods work best in low light. Rods perceive blacks, whites, and grays, but not colors. They detect general shapes. Rods are used for night vision and peripheral vision. High concentrations of rods at the outer portions of your retina act as motion detectors in your peripheral or side vision.

The receptor cells in the retina send nerve messages about what you see to the optic nerve. The optic nerves extend from the back of each eye and join together in the brain at the optic chiasm. From the optic chiasm, the nerve signals travel along two optic tracts in the brain and eventually to the occipital cortex.

Causes

Intraocular tumors occur when cells grow abnormally and form a mass. Intraocular tumors may be cancerous or noncancerous. Primary eye cancer, cancer that originates in the eye, is rare. Metastatic eye cancer results when cancer from another part of the body spreads to the eye.

There are several different types and locations of intraocular tumors, some of which are described below:

Choroidal Hemangioma

A choroidal hemangioma is not cancerous. The tumor is made of blood vessels. It is located in the choroid layer of the eye. A choroidal hemangioma can affect vision if it is located in the central visual area. It may lead to retinal detachment if the blood vessels leak.

Choroidal Metastasis

Choroidal metastasis is cancer that spreads from other parts of the body to the eye. They most frequently develop from breast cancer, male lung cancer, lymphomas, leukemias, and cancer of the prostate, kidney, thyroid, or gastrointestinal tract.

Choroidal Nevus
Choroidal nevus is similar to freckles on the skin. Because choroidal nevus has the potential to become cancerous, it is monitored very closely by an ophthalmologist.

Conjunctival Tumors

Conjunctival tumors are cancers that grow on the outside of the eye. They include squamous cell, malignant melanoma, and lymphoma. Squamous cell is the most common type of conjunctival tumor. It rarely spreads, but may grow into the eye socket and sinuses. Malignant melanomas may start as a freckle or grow from a colored area.

Iris Tumors
Iris tumors may grow inside of or behind the iris. Many iris tumors are noncancerous, although some malignant melanomas can occur in the iris.

Leukemia and Lymphoma

Lymphoma tumors can grow in the eyelids, tear ducts, or in the eye. Most people with large cellnon-Hodgkin’s lymphoma have tumors that are confined to the eye and the central nervous system. For people with non-Hodgkin’s lymphoma, symptoms in the eye typically appear about two years before they manifest in other parts of the body.

Melanoma of the Eye

A melanoma is a very aggressive form of cancer that can spread to other parts of the body. Melanoma occurs most commonly in the choroid, but it may also develop in the iris or ciliary body. Melanoma is the most common type of eye tumor in adults, although primary eye melanoma is rare. Melanomas may lead to distorted vision and retinal detachment.

Symptoms

Intraocular tumors do not always produce symptoms. Symptoms to be aware of include color changes in any part of your eye, the appearance of new spots or freckles, changes in existing spots or freckles, vision changes, poor vision in just one eye, bulging, swelling, pain, or redness. You should report any changes in your eye’s appearance or vision to your doctor.

Diagnosis

A doctor can diagnose intraocular tumors by reviewing your medical history and performing a thorough eye examination. Your eye examination will include visual acuity and refraction. Visual acuity tests how well you can see. Refraction is used to determine the degree of the refractive error. The information is used to write a prescription for glasses.

Your eye examination will also include slit-lamp testing, in which your doctor uses a slit light and a microscope to view your inside eye structures. Your eyes may be tested for glaucoma with pressure testing (tonometry).

Imaging tests may be used to create pictures of your inner eye structures. Imaging tests may identify abnormal growths. There are several types of imaging tests, some with complex names.

Fluorescein angiography uses an injected dye and a special camera to take photos of the blood vessels in the eye. It does not involve radiation.

ICG angiography is a high-speed photographic eye test that is used to detect blood circulation problems in the eye. The test uses an injected dye and special cameras to take photos of the blood vessels.

OCT is a new imaging technology that helps visualize the retina. OCT takes cross-sectional pictures of the retina.

Fundus photography is used to take pictures of the back of your inner eye. The highly specialized photos are used to diagnose, document, compare, and monitor eye conditions.

Ultrasound, also referred to as echography, uses high frequency sound waves to produce images of the internal eye structures. It is a helpful diagnostic tool if cataracts or other conditions prevent a doctor from viewing inside of your eye with traditional methods.

If you are diagnosed with a cancerous tumor, your doctor may order imaging tests to gather more information about your tumor and if it has spread. Computed tomography (CT) scans or magnetic resonance imaging (MRI) scans are used to create images of the eye and brain.

Treatment

The treatment that you receive depends on the type, size, location, extent, and cause of your tumor. Treatment also depends on if your tumor is cancerous or noncancerous. It is not always necessary to remove noncancerous tumors. It is not always necessary to remove small slow growing cancerous tumors immediately. Many intraocular tumors are monitored regularly for signs of change or evidence of growth.

Tumors may be removed if they interfere with vision, if they are growing cancers, or if they are they have a tendency to spread. There are several options for tumor treatment and removal. Your doctor will carefully explain your condition and the most appropriate treatment options for you. Depending on your condition, treatment options may include cryotherapy (freezing), external beam radiation therapy, radiation plaque therapy, photodynamic therapy (PDT), enucleation, and chemotherapy.

Cryotherapy may be recommended for conjunctival tumors. It involves using very cold temperature to destroy tumor cells. A local anesthesia is used for cryotherapy.

External beam radiation therapy may be used for choroidal metastasis, choroidal hematomas, choroidal hemangiomas, lymphomas, and orbital tumors. It uses high-beam radiation to destroy cancer cells and shrink tumors.

Radiation plaque therapy, also called brachytherapy, may be used for choroidal melanoma or iris melanoma. It is considered an “eye sparing” treatment because it affects tumor cells and decreases damage to surrounding cells. A radiation plaque or “seed” is surgically implanted in the eye. It delivers low dose radiation to destroy cancer cells and shrink tumors.

PDT may be used to treat choroidal hemangiomas and selected abnormal tissue. PDT can destroy cancer cells with a laser light. The process uses a photosensitizing agent that is injected into the bloodstream. An advantage of PDT is that it causes minimal damage to surrounding tissues.

Enucleation involves surgically removing the eyeball. Enucleation is done if there is no other possible treatment for intraocular cancer. It results in permanent vision loss. A realistic artificial eye, called an ocular prosthesis, may be implanted to replace the eyeball.

In some cases, chemotherapy may be necessary to treat cancer, although it is rarely used for primary eye cancer. Chemotherapy uses various combinations of drugs to fight cancer. Chemotherapy is usually received over a period of time.

The experience of intraocular cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support from a positive source.

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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