An Overview of Eye Tumors

The Difference Between Malignant and Benign Growths

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Eye tumors, also known as ocular tumors, are tumors associated with the eye. A tumor is a collection of cells that grows abnormally, and it can be malignant (cancerous) or benign (usually harmless). The most common type of eye tumor is metastatic—this is a secondary tumor caused by cancer that has spread from one part of the body to another, often coming from the lung, breast, bowel, or prostate.

Although rare, ocular melanoma is the most common adult tumor that forms in the eye. It is sometimes called "uveal" melanoma or "choroidal" melanoma. It forms from pigmented cells in the eye and occurs in three main areas of the eye: the iris, ciliary body, and the choroid. These three regions of the eye collectively make up the “uvea.”

Most eye melanomas occur in the choroid, which is located between the retina and the sclera. Other less common types of primary intraocular tumors include intraocular lymphoma, retinoblastoma, and hemangioma. Other rare cancers of the eye include conjunctival melanoma, eyelid carcinoma, and lacrimal gland tumor.

Symptoms

Eye moles, like skin moles, develop when certain cells grow together in a group. You may notice an abnormal brown spot on or in your eye. Referred to as nevi, these benign moles usually develop on the choroid, iris, or conjunctiva of the eye.

An eye tumor may first appear as a dark spot on the iris, the colored part of your eye. If you notice a spot in your eye, it is best to inform your doctor. Occasionally, people who suffer from eye tumors may have blurry vision or complain of floaters (the visible shadow of fibers that appear in your vision).

Most people have no symptoms of eye tumors at all, and they are often discovered during routine eye examinations.

If you have a spot on or close to your eye growing larger or changing shape or color, notify your doctor immediately—not all eye tumors are benign.

Benign Eye Tumors

Benign eye tumors can grow on the eyelid or within the wall of the eye. These are called choroidal nevi, which are pigmented lesions found inside the eye. Benign eye tumors can develop from abnormal growth of blood vessels inside or surrounding the eye, called hemangiomas.

Choroidal hemangioma is the most common type of non-cancerous eye tumor. Non-cancerous tumors of the eye might appear with these signs and symptoms:

  • Bulging or protrusion of the eye (usually painless)
  • Redness
  • Changes to vision
  • Burning
  • Itching
  • Swelling
  • Feeling like something is in your eye

Malignant Eye Tumors

Several types of cancers can affect the eye. Orbital cancers affect the tissues surrounding the eyeball (called the orbit), including muscles that move the eyeball and nerves attached to the eyeball. Adnexal structures include the eyelids and tear glands. Cancers that develop in these tissues are called adnexal cancers.

Malignant melanomas usually form from simple moles, which is why you need to check them often for changes. If you have a mole in or near your eye, it should be examined regularly. Not all cases of eye cancer produce symptoms, but the following could be present:

  • Flashes of light
  • Visual distortion
  • Loss of vision
  • Floating objects (floaters)
  • Irregularly shaped pupil
  • Glaucoma

Early detection of cancer often allows for more treatment options. Although not all cancers of the eye can be detected early, some types of eye cancers have noticeable symptoms. It is very important to schedule regular eye exams, as many eye diseases do not produce symptoms.

If your doctor determines that you are at higher risk for eye melanoma, you may be recommended to have an eye exam every year—eye melanomas are often found during routine exams.

Causes

Benign Eye Tumors

A non-cancerous, benign tumor of the eye is a growth that does not spread to other parts of the body. There are several types of benign eye growths that should be differentiated from malignant eye growths. Many of these are more often associated with the skin around the eye and the eyelid.

Some eye tumors can appear on the conjunctiva, the clear tissue that lies on top of the sclera—the white part of the eye—and some are inside the eyeball itself, making it difficult for anyone to see them aside from a doctor.

Typically, growths that appear suddenly are infections and inflammations rather than a benign growth of cells.

Benign tumors and growths on the skin around the eye, eyelid, and the conjunctiva are commonly caused by exposure to both wind and ultraviolet rays from the sun. Some benign growths are thought to be caused by a virus.

Others appear due to a change related to aging. Large pigmented lesions or moles can be genetic or a part of an overall syndrome related to a medical problem.

Freckles and growths inside the eye are most often a benign choroidal nevus or congenital hypertrophy of the retinal pigment epithelial layer, also called CHRPE for short. These are usually just an accumulation of pigmented cells that appear darker. Although most are benign, there is a very small chance a choroidal nevus can become cancerous.

The presence of one or two CHRPE lesions is usually no cause for concern. However, multiple CHRPE lesions have been associated with an increased risk of developing colon cancer.

Malignant Eye Tumors

Cancer is caused by changes (mutations) to DNA within cells. The DNA inside a cell contains a set of instructions telling the cell what functions to perform, and how to grow and divide. Errors in the instructions can cause the cell to stop its normal function, allowing a cell to become cancerous.

Several factors can contribute to gene mutations including inherited gene mutations and gene mutations that occur after birth. You may be born with a genetic mutation. Some mutations can be inherited and passed down through families. This type of mutation accounts for a small percentage of cancers.

On the other hand, most gene mutations occur after you're born. Many things can cause gene mutations including smoking, radiation exposure, viruses, carcinogens, obesity, hormones, chronic inflammation, and lack of exercise.

Risk Factors for Eye Cancer

  • Age
  • Race
  • Medical History
  • Family History

Age and Race

Primary intraocular melanoma generally develops in people over the age of 50, with the average age of diagnosis being 55. This type of eye cancer is rare in children and people over the age of 70.

It also occurs more commonly in white people and less commonly in black people. (Men and women are equally affected by intraocular melanoma.)

Medical History

Basal cell carcinoma, squamous carcinoma, sebaceous carcinoma, and malignant melanoma are all types of eyelid cancers. People who have extra pigmentation of the eye or skin around the eye, spots like moles in the eye, or multiple flat moles that are irregular in shape or color are more likely to develop intraocular melanoma.

Family History

Intraocular melanoma also sometimes runs in families. Usually, it develops due to a mutation or change in a gene. Sunlight or certain chemicals may increase the risk of intraocular melanoma development.

Retinoblastoma is an eye cancer that affects young children and is caused by a genetic mutation. It begins in the retina, the light-sensitive tissue lining the back of the eye. Retinal nerve cells begin to grow and multiply, then usually spread into the eye and possibly to other parts of the body.

If you have any of the risk factors associated with developing cancer of the eye, you should see an ophthalmologist each year for a thorough examination. Also, be sure to protect your eyes from ultraviolet (UV) radiation by wearing sunglasses.

If you see an unusual mole or other skin growth on or around your eye, consult your ophthalmologist.

Diagnosis

An optometrist or ophthalmologist can usually readily tell the difference between malignant eye lesions and benign lesions when they occur around or in the eye. Sometimes a dermatologist will also become involved, depending on the type of growth.

If deemed suspicious at all, the lesion will be cut off or excised and sent to a laboratory for testing to see if it is benign or possibly cancerous.

A pathologist will determine if a growth is cancerous and send a report back to the treating doctor. Lesions inside the eye are studied in a variety of ways.

Eye doctors will usually take a digital photograph of the lesion and monitor it for growth or changes over time.

Sometimes, eye doctors will perform an ultrasound of the lesion to determine how solid or reflective the growth may be. Growths inside the eye that are benign usually have distinct margins and are flat or slightly raised. Malignant lesions may have a more irregular shape, pigmentary changes, and have fluid on the top.

Your doctor will use many tests to make a diagnosis of eye cancer. If eye melanoma is suspected, she may recommend a variety of tests.

Eye Exam: Your doctor will thoroughly examine your eyes, both outside and inside. Enlarged blood vessels on the outside of your eye is usually a sign of a tumor inside your eye. Your doctor may then look deep inside your eye with the help of a binocular indirect ophthalmoscope (BIO). This instrument uses lenses and a bright light to see inside the eye. A slit-lamp may also be used to view the interior structures of your eye.

Eye Ultrasound: An eye ultrasound may be used to produce images of the inside of your eye. The ultrasound transducer is placed on your closed eyelid or near the front surface of your eye.

Optical Coherence Tomography (OCT): OCT is an imaging test used to create pictures of the inside of your eye.

Fluorescein Angiography: For this procedure, a fluorescent dye called fluorescein is injected into your arm. The dye moves through your body and into the blood vessels in the back of the eye, allowing your doctor to take pictures.

Fine Needle Biopsy: During this procedure, your doctor will remove tumor cells from your eye with a needle. The cells can then be studied under a microscope. However, eye melanoma can almost always be diagnosed accurately without a biopsy, so this procedure is not usually needed.

If you are diagnosed with eye cancer, imaging tests may be ordered to find out whether the cancer has spread to other parts of your body.

Treatment

Benign Lesions

Benign lesions on the outside of the eye can be removed surgically. They can also be removed with certain chemicals or cauterization. If freckles and growths inside the eye are truly determined to be benign, they are usually left alone to be examined every six to 12 months for any possible changes.

Eye Cancer

Treatment for eye cancer will aim to reduce the risk of spreading and to maintain the health and vision of your eye, if possible. Treatment options for eye cancer depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s overall health.

People with eye cancer are sometimes treated using a multidisciplinary team approach. With this type of plan, you may have several specialists using several types of treatment to maximize the chances of a successful outcome.

How eye cancer is treated depends on the tumor and whether the cancer has spread to other areas of the body. The goal of treatment is to save vision whenever possible. Depending on your diagnosis, your treatment plan may include the following:

  • Surgery. Surgery is common in the treatment of eye cancer. During surgery, your ophthalmologist may remove parts of your eye depending on the size and spread of the tumor.
  • Eye removal. In some cases, the only choice for treatment is to remove the eye. Depth perception will be compromised due to the loss of vision, but most people adjust fairly quickly.
  • Radiation therapy. Radiation therapy is used by radiation oncologists to destroy cancer cells. Radiation therapy usually consists of a set number of treatments over a period of time.
  • Laser therapy. Laser therapy uses lasers to shrink tumors. This treatment normally has fewer side effects than surgery or radiation therapy.

A Word From Verywell

If you notice any symptoms of an eye tumor on or near your eye, it's best to contact your doctor immediately. There are many different kinds of eye tumors; while some are not harmful and require no treatment, others are more severe and may require testing to determine if they are benign (usually harmless) or malignant (cancerous).

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Article Sources
  • Leung, Loh-Shan, MD and Mark S. Blumenkranz, MD. Ocular Tumors, American Academy of Ophthalmology (AAO).

  • Editorial Board. Eye Cancer: Overview. American Society of Clinical Oncology (ASCO).

  • Porter, Daniel. What Is Ocular Melanoma? American Academy of Ophthalmology (AAO).