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What is Ocular Oncology?

Ocular oncology covers the management of all tumors involving the eye, eyelid, orbit and lacrimal glands. Ocular tumors affect adults and children, and tumors may occur in one eye or may involve both eyes. Eye cancer can affect all parts of the eye.

Types of Ocular Oncology

Some common ocular cancers include choroidal melanoma, choroidal hemangioma, retinoblastoma, eyelid tumor, conjunctival tumor and lymphoma/leukemia.

  • Choroidal melanoma

    Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body. It is nevertheless an infrequently found tumor. Choroidal melanoma is a subtype of uveal melanoma. Uveal melanomas can be divided into 2 categories: (1) anterior uveal melanomas, in which the tumor arises in the iris, and (2) posterior uveal melanomas, in which the tumor arises in either the choroid or the ciliary body. Intraocular melanomas simultaneously can involve more than 1 uveal structure.

  • Choroidal Hemangioma

    Choroidal hemangioma are typically reddish to orange. Choroidal hemangioma can have areas of increased pigmentation which (in those cases) can make them difficult to differentiate from choroidal melanomas. Choroidal hemangiomas can cause far-sightedness (hyperopia), distorted vision (metamorphopsia), flashing lights, or blurred vision. Many choroidal hemangioma cause no symptoms at all, and are found on routine dilated eye examinations (ophthalmoscopy).

  • Retinoblastoma

    Retinoblastoma - (Reh-tin-oh-blast-oma) is a cancer of one or both eyes which occurs in young children. The retinoblastoma tumor(s) originate in the retina, the light sensitive layer of the eye which enables the eye to see. When the tumors are present in one eye, it is referred to as unilateral retinoblastoma, and when it occurs in both eyes it is referred to as bilateral retinoblastoma.

  • Eyelid Tumor

    Eyelid tumors are the source of most eye related cancer. Cancer in the eye’s interior tissue is rare. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Eyelid cancer is a general term for a cancer that occurs on or in the eyelid and is broadly categorized as an epithelial (outer surface) tumor. An eyelid tumor can begin from sebaceous (fat), sweat, or apocrine glands (a type of sweat gland).

  • Conjunctival Tumor

    Conjunctival tumors usually first appear as a spot or slightly raised area against the white background of the eye and are diagnosed by an eye doctor using a slit lamp. The only way to determine whether such a tumor is benign or malignant is to examine a portion of the tissue under a microscope. Although malignant tumors are seldom seen, they must be treated with either radiation or surgical removal. Conjunctival tumors affect the clear, membrane-like tissue that covers the white of the eye -- the conjunctiva.

  • Ocular Lymphoma/Leukemia

    Whereas Hodgkin lymphoma very rarely causes ocular disease, non-Hodgkin lymphoma (NHL) is the most common type of ocular lymphoma. Depending on the site of involvement, ocular lymphoma can be either intraocular or orbital and adnexal.

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Treatment

  • Depending on the type of cancer and location, options may include chemotherapy (topical for anterior surface tumors, injectable about the eye, or systemic administration), cryotherapy (use of low temperatures), external beam radiation, radiation plaque therapy (also called brachytherapy) and surgical excision of the tumor. Oculoplastics physicians or tumor surgeons offer reconstructive surgery and prosthetic devices, tailored to each individual patient's case.

  • Chemotherapy

    Systemic chemotherapy (chemo) is the use of anti-cancer drugs that are injected into a vein or are taken by mouth. These drugs enter the bloodstream and reach throughout the body, making this treatment very useful for cancers that may be in more than one part of the body. Chemo can be useful for treating intraocular lymphoma, but it is used less often for intraocular melanoma.

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  • Cryotherapy

    Cryotherapy is a means of freezing the retina where a retinal tear has occurred. This keeps the retina stuck in its proper place inside of the eye. The cryo probe is placed on the outside of the eye over the area of the tear. The doctor uses a light mounted on his head and a lens held in his hand to check the position of the probe and make sure it is in the right place. The probe is turned on and a small area is frozen in a few seconds. You will notice a cold feeling in that area.

  • Cryotherapy

    Cryotherapy is a means of freezing the retina where a retinal tear has occurred. This keeps the retina stuck in its proper place inside of the eye. The cryo probe is placed on the outside of the eye over the area of the tear. The doctor uses a light mounted on his head and a lens held in his hand to check the position of the probe and make sure it is in the right place. The probe is turned on and a small area is frozen in a few seconds. You will notice a cold feeling in that area.

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  • External Beam Radiation

    External beam radiotherapy or teletherapy is the most common form of radiotherapy. The patient sits or lies on a couch and an external source of radiation is pointed at the eye. It results in highly effective regression of vascularized retinal tumors. It is applicable to eyes containing one or more tumors that involve the optic disc, eyes that show diffuse intravitreal or subretinal seeding, and eyes for which prior chemotherapy or local treatments such as laser therapy, cryotherapy or plaque radiotherapy have failed.

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  • Radiation Plaque Therapy or Brachytherapy

    It is the most widespread method of delivering therapeutic doses of radiation to intraocular tumors including choroidal melanoma. The radioactive plaque can also be called a “radiation implant” or “radioactive source.” Plaque brachytherapy is typically used alone. In certain cases your physician may want to add laser photocoagulation. The radiation sources used for brachytherapy come in the form of small "rice-sized" radioactive seeds. These seeds are attached within a gold or steel bowl called a plaque.

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Surgical Excision of the Tumor

For decades, surgical removal of the eye, known as enucleation, was the only treatment for ocular melanoma. Enucleation remains a standard treatment for the disease today but proton-beam therapy has a higher success rate.