About eye cancer

About eye cancer
Eye cancer is caused by an uncontrolled growth of cells. It can develop in or around the eye. There are several different types of eye cancer.

Types of eye cancer
Cancer that develops in the eye is called intraocular cancer. Cancer that develops outside the eye is called extraocular cancer. Below are the most common types.

Intraocular cancers
Non-Hodgkin's lymphoma
This type of cancer usually develops in lymph nodes. The lymph nodes are glands throughout your body that make up part of your immune system (the system that helps protect your body from infections). However, non-Hodgkin's lymphoma sometimes develops in the eye.

Ocular melanoma
Melanoma develops from cells that contain the pigment melanin. It most commonly occurs on the skin. But it can also develop inside the eye, where it is called ocular melanoma.

Melanoma is the most common type of intraocular eye cancer, though it's still rare. It is most commonly diagnosed in people over 50.

Ocular melanoma usually develops in the uveal tract in the eye. The uvueal tract consists of the choroid layer (the lining of your eyeball), the ciliary body (which contains the muscles that focus the eye), and the iris (the coloured part of your eye). Melanoma can also starts in the inner surface of eyelids (conjunctiva) or the eyelids.

Retinoblastoma
This type of intraocular eye cancer develops in young children, usually under the age of 5. It is often inherited. In nine out of 10 cases it can be cured.

Extraocular cancer
Non-melanoma skin cancers
Basal cell carcinoma is the most common type of skin cancer in the UK. It often develops near your eye, especially on the lower eyelid. It causes a small red growth on the skin that often has a pearly edge to it. It doesn't usually spread to other parts of the body but it can affect surrounding tissue if it isn't treated. Basal cell carcinoma can usually be removed with surgery if caught early, but sometimes radiotherapy is used to treat it (see Treatment). Squamous cell carcinoma is another type of skin cancer that can develop on the skin of your eyelid, but it is quite rare. It develops on the surface of the eyeball or the conjunctiva. It can sometimes spread to lower levels of the skin. It's usually treated with radiotherapy, although it may need surgery as well (see Treatment). Rhabdomyosarcoma
This is a very rare extraocular cancer that most commonly affects children. It develops in the muscles that move the eye.

Optic nerve tumours
Rarely, a tumour can develop in your optic nerve. The optic nerve connects your eye to the brain. Optic nerve tumiurs are usually treated with surgery (See Treatment).

Symptoms
The symptoms of eye cancer vary depending on the type of cancer and where it is located.

Intraocular cancers such as ocular melanoma have no symptoms. They are usually detected in routine eye examinations. This is one of the reasons it's important to have regular eye tests. The College of Optometrists recommends having an eye examination every two years unless you are advised otherwise.

Some eye cancers cause symptoms. However it's important to remember that these are usually caused by other eye problems and only rarely mean that you have eye cancer. These symptoms are:

loss of some or all of your vision flashing lights or spots in your vision a dark spot on your iris that is growing a visible lump on your eyelid with crusting or bleeding pain in or around the eye (although this is rare with cancer) bulging of an eye In children a squint or odd looking pupil may be a symptom of retinoblastoma. If you notice this, you should take your child to your doctor.

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Causes

Causes

The exact reasons why cancer of the eye develops aren't fully understood. However, some things increase your risk of certain types. For example:

-if you have blue, grey or green eyes you are more likely to develop melanoma of the eye.
-if you have lots of moles that are unusually shaped or especially large (a condition called atypical mole syndrome) this may increase your chances of developing melanoma of the eye.
-exposure to ultraviolet rays (UV) in sunlight increases your risk of getting melanoma of the eye - wearing UV protective sunglasses can reduce your exposure.
-having a weakened immune system increases your chances of developing lymphoma of the eye.
-retinoblastoma is often caused by inheriting a faulty gene from your parents

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Diagnosis

Diagnosis

If your doctor thinks that you have cancer of the eye, he or she will arrange for you to have some tests to help with diagnosis. You may be referred to a doctor who specialises in eye conditions (an ophthalmologist), and perhaps to a doctor who specialises in cancer (an oncologist) as well.

There are several different types of tests you could have, depending on the type of cancer you are suspected of having.

Ophthalmoscopy
This test is similar to a regular eye test. Your ophthalmologist will use several different instruments to examine the inside of your eye.

Fluorescein angiography
In this test, a dye called fluorescein is injected into your arm. This travels through your blood to vessels in your eyes. A photograph of your eye is taken with a special camera fitted with filters that make the dye visible. The blood vessels inside your eye can then be examined on the photograph.

Ultrasound scan
After giving you some eye drops, your doctor will move a small ultrasound probe over the surface of your eye (through closed eyelids) or on the skin around it. The probe produces sound waves which are used to create an image of the inside of your eye.

Computerised tomography (CT) scan
You may have a CT scan of your head. A CT scan uses X-rays to make a three-dimensional picture of the inside of a part of your body. This helps to show up tumours in and around your eye and whether they have spread.

Magnetic resonance imaging (MRI) scan
An MRI scan uses magnets and radio waves to produce images of the inside of your body. This is sometimes used to find eye tumours.

Biopsy
Sometimes your doctor will want to take a biopsy. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to find out what type of cancer you have. The procedure can be carried out under local or general anaesthetic.

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Treatment

Treatment

The treatment you will receive will depend on the type of eye cancer you have, how far it has spread and your general state of health. There are three main treatments for eye cancer.

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Surgery

Surgery

Some eye tumours can be removed by surgery. This can involve removing just the tumour, or the part of the eye it is growing in. Surgery is usually enough to remove most tumours of the eyelids. It's sometimes combined with radiotherapy for treating intraocular tumours.

Some tumours, such as melanoma of the eye, can be treated with laser therapy, which is used to kill the cancer cells.

Occasionally the tumour has spread too far to be safely removed on its own and the whole eyeball may need to be taken out (enucleation). Having this treatment can make people feel upset or worried about how they will cope. The doctors and nurses looking after you will support you during this time and will be able to help and advise you. An artificial (prosthetic) eyeball can be created to match your remaining eye.

Remembered that eye cancer is very rare. Most eye symptoms are due to other causes. However, having a regular eye check is important, as is seeing your doctor if you have any symptoms that you are concerned about.

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Non-surgical treatments

Non-surgical treatments

Radiotherapy
Radiotherapy uses radiation to kill cancer cells. It is often used for treating melanoma of the eye.

A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. Alternatively a source of radiation is implanted next to the tumour in an operation. This is called brachytherapy. You will need to stay at hospital until it's removed in another operation about a week later.

Chemotherapy
Chemotherapy uses medicines to destroy cancer cells. There are lots of chemotherapy drugs. They are usually injected into a vein but sometimes you may be given tablets.

These drugs can cause a variety of side effects, such as making you feel tired or ill. They can also cause nausea or hair-loss. Your specialist will advise you about what side effects to expect.

Chemotherapy can be effective for treating lymphoma of the eye and retinoblastoma. It isn't usually used for melanoma of the eye unless other types of treatment haven't worked.

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Long-sightedness

About long-sightedness
Long-sightedness is a refractive error, like short-sightedness (myopia). That means there is an error in the amount that your eye bends light rays.

Normal vision
When you look at something, light rays from the object pass into the eye through the cornea - the clear dome that covers the pupil - then through the lens towards the retina at the back. In a healthy eye the lens and cornea focus the light rays on a small area of the retina so that you can see the object clearly.

Long-sightedness or hyperopia
In long-sightedness, light rays are focused behind the retina, because the eyeball is too short, the cornea is not curved enough or the lens not thick enough. Eyeball length is the most important factor. Close objects seem fuzzy or blurred. Distant objects don't look blurred, because the light rays enter the eye at a slight angle. This means they focus on the retina properly.

Corrected hyperopia
A convex lens - from a pair of glasses or contact lenses - refocuses light rays onto the retina, returning your vision to normal.

Symptoms
Symptoms of long-sightedness are listed below.

Close objects appear fuzzy or blurry, while distant objects remain in focus. Headaches or tired eyes. In young people with long sight, the eyes can still focus on near objects, for example when reading a book. But the muscles in the eye have to contract more to allow this. So you might find that you get headaches when you read, write or do other near work, and that your eyes feel tired. Squints. In some children, a squint can develop, where one eye points inwards more than the other. If a squint is not treated in a baby or young child, it can lead to permanent vision problems. It's important that you take your child to see a GP if you're worried that he or she has a squint. Causes
Long-sightedness may develop in childhood. You're more likely to develop it if there's a history of it in your family.

Between the age of 45 and 65, the lens in your eye becomes stiffer. This means you might not be able to focus on near objects as well any more, but can still see distant objects clearly. This is called age-related long-sightedness or presbyopia.

Diagnosis
If you can see far objects more clearly than near objects, you should visit an optometrist and get your eyes tested.

It's important to have regular eye tests. As well as diagnosing any vision problems, they can reveal other serious illnesses, like diabetes or high blood pressure. The College of Optometrists advise that you should have an eye test at least every two years. Depending on your age, or if you have any known sight problems or illnesses that affect vision, you may need them more frequently - ask your optometrist or GP for more advice.

Treatment
Glasses and contact lenses
Long-sightedness can usually be corrected by wearing glasses or contact lenses. Some people wear contact lenses, while others feel more comfortable in glasses. Your optometrist will discuss with you what options are available.

Contact lenses tend to be more expensive than glasses, and you have to be comfortable touching your eyes to use contact lenses. Some people find they see better with contact lenses than glasses. Speak to your optometrist about the pros and cons of different types of lenses.

Wearing contact lenses can increase the risk of getting an eye infection. You can reduce the risk by making sure you follow all the advice of your contact lens practitioner.

Glasses are usually recommended for children. They're also easier than contact lenses for elderly people. Glasses are a better option for those who find contact lenses fiddly and don't like touching their eyes.

Surgery
Laser refractive surgery
Laser surgery to correct refractive errors such as long-sightedness has become increasingly popular. Laser refractive surgery isn't suitable for everyone, and you'll need to talk to an ophthalmic surgeon to find out if it's right for you.

A laser is used to make alterations to the cornea, so that light rays are correctly focused onto the retina. There are various types, which differ according to how the surgeon gains access to the cornea. These include PRK (photorefractive keratectomy), LASEK (laser epithelial keratomileusis) and LASIK (laser in situ keratomileusis). Another option, called thermokeratoplasty, is available for mild long-sightedness.

The operation is carried out under local anaesthetic, so you're awake throughout. It only takes a few minutes.

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Short-sightedness

About short-sightedness
To understand what myopia is, it helps to know how our eyes focus. The diagrams below show normal vision, short-sightedness and corrected myopia.



Normal vision
When you look at something, light rays from the object pass into the eye through your cornea - the clear structure at the front of your eye - then through the lens towards the retina at the back of your eye. In a healthy eye the lens and cornea focus the light rays on a small area of your retina so that you can see the object clearly.

Short-sightedness or myopia
If your cornea is too curved, or your eyeball too long, light rays from distant objects focus in front of your retina. This makes objects seem fuzzy or blurred.

Nearby objects don't look fuzzy, because the light rays enter your eye at a slight angle. This means they focus on your retina properly.

Corrected myopia
The bottom diagram shows how a lens - from a pair of glasses or contact lenses - refocuses light rays onto your retina, returning your vision to normal.

Symptoms
Short-sightedness causes distant objects to appear blurry and unfocused, while nearby objects remain in focus.

Causes
Myopia usually develops in children or young teenagers. You are more likely to develop myopia if it runs in your family.

Temporary short-sightedness, called pseudomyopia, can be caused by certain diseases or drugs. For example, myopia can be the first sign of type 2 (non-insulin-dependent) diabetes. Pseudomyopia usually clears up if the underlying cause is treated.

Diagnosis
If you are straining to see things in the distance you should visit an optometrist and get your eyes tested. It's important to get regular eye tests. As well as diagnosing any vision problems they can reveal other serious illnesses, such as diabetes or high blood pressure.

According to the College of Optometrists, you should have an eye test every two years. Depending on your age, or if you have any known sight problems or illnesses that affect vision, you may need one more often. Ask your optometrist or GP for more advice.

Some people are only mildly short-sighted and need to wear glasses or contact lenses only occasionally, such as when driving. Others need to wear glasses or contact lenses all of the time.

Young children may not realise that they have blurred vision. If a child frowns or squints a lot, or has trouble seeing the TV, then he or she might have myopia.

Myopia is usually diagnosed by reading a standard chart (called a Snellen chart) from a distance of six metres. The chart has large letters at the top and small ones at the bottom.

Treatment
Glasses and contact lenses
Short-sightedness can usually be corrected by wearing glasses or contact lenses. Some people wear contact lenses, but others feel more comfortable in glasses. Your optometrist will discuss with you what options are available.

Contact lenses tend to be more expensive than glasses, and you have to be comfortable touching your eyes to use them. They need to be kept clean and some types require a lot of care. A popular type of modern contact lens is the daily disposable contact lenses, which are worn for one day and then thrown away. When you wake up the next morning you put in a brand new pair. There is no cleaning or storing with these lenses.

Glasses are usually recommended for children. They are also easier than contact lenses for older people. Glasses are also a better option for those people who find contact lenses fiddly and don't like touching their eyes.

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