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Eye cancer covers several uncommon tumours. In adults the most frequent cancer starting inside the eye is uveal melanoma, which arises in the choroid, ciliary body or iris. In young children it is retinoblastoma. Cancers can also affect the conjunctiva, the eyelids and the eye socket, and lymphoma can involve the eye.

Modern treatment often saves the eye and sometimes useful vision, but not always. Uveal melanoma can spread, chiefly to the liver, even years later, so lifelong checks are part of care. These tumours should be managed by an ocular oncology service.

Symptoms

• No symptoms, with a pigmented lesion seen at a routine eye test
• Blurred or distorted vision in one eye
• Flashing lights, floaters or a shadow in the field of vision
• A dark spot on the iris that is growing, or a change in pupil shape
• A white reflex in a child's pupil in photographs, or a new squint
• A growing fleshy or pigmented patch on the white of the eye
• A bulging eye or a lump on the eyelid that does not heal

Causes and risk factors

Uveal melanoma is more common in people with fair skin and light-coloured eyes, in those with many atypical moles or a naevus inside the eye, and rarely in families carrying a BAP1 gene change. Unlike skin melanoma, its link to sunlight is weak. Retinoblastoma is caused by changes in the RB1 gene; around 40 percent of cases are heritable, often affect both eyes and have implications for brothers, sisters and future children. Conjunctival and eyelid cancers are related to ultraviolet exposure, and conjunctival cancer also to HPV and weakened immunity.

How it is diagnosed

• Dilated eye examination: An ophthalmologist examines the inside of the eye with the pupils widened. Many melanomas are diagnosed from their appearance alone.
• Ultrasound of the eye: Measures the thickness and internal features of the tumour, which guides the choice of treatment.
• OCT, photography and angiography: Document the lesion and help distinguish a harmless naevus from a small melanoma.
• Examination under anaesthesia and MRI: Standard for children with suspected retinoblastoma. Biopsy is avoided in retinoblastoma because it can spread tumour cells.
• Biopsy and genetic profiling: Sometimes done in uveal melanoma to estimate the risk of spread, plus liver imaging at diagnosis and during follow-up.

Treatment options

• Plaque brachytherapy: A small radioactive disc stitched to the outside of the eye over the tumour for a few days. The most common eye-saving treatment for uveal melanoma.
• Proton beam or stereotactic radiotherapy: For tumours not suitable for a plaque because of size or position near the optic nerve.
• Enucleation: Removal of the eye for large tumours or a blind painful eye, followed by an orbital implant and a matched artificial eye.
• Retinoblastoma treatment: Chemotherapy by vein or directly into the eye's artery, laser, freezing treatment and sometimes enucleation, in a specialised paediatric unit.
• Surface and eyelid tumours: Surgical excision with freezing treatment, chemotherapy eye drops for conjunctival tumours, and margin-controlled surgery with eyelid reconstruction.

When it is urgent

Seek same-day eye care close to home for sudden loss of vision, a curtain across the vision, a very painful red eye, or an eye that suddenly bulges. A white pupil or new squint in a baby or young child needs a specialist eye examination within days, not weeks. These are not reasons to wait for a planned journey.

Travelling to Türkiye for treatment

Ocular oncology exists in only a few centres in any country, so travelling for it is common and reasonable. A visit can provide an expert diagnosis of a suspicious lesion, and plaque brachytherapy needs roughly 7 to 10 days including insertion and removal. Follow-up eye examinations and liver scans every 6 to 12 months continue for life and should be arranged at home. Retinoblastoma treatment involves repeated anaesthetics over many months, so families need to weigh a long stay against care nearer home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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