Eye Oncology

Eye oncology is a unique field of Ophthalmology, which includes the diagnosis and treatment of benign and malignant eye tumors. The tumors can develop on the surface of the eye or within the eye itself.

Benign surface ocular tumors include papilloma, conjunctivitis, pterygium, and other, less common tumors.

Malignant tumors are divided into epithelial tumors (conjunctival intraepithelial neoplasia (CIN), invasive squamous cell carcinoma), tumors originating from lymphoma cells and melanocytic tumors (primary acquired melanosis, melanoma).

Conventional treatment of ocular surface tumors includes surgical removal and adjuvant therapy – chemotherapeutic, immunomodulatory drops and/or local radiation. In certain situations the condition can be monitored without interference, however in such a case close observation by an ophthalmologist specializing in tumors is necessary.

1. Choroidal nevus is the most common intraocular tumor. This is a benign tumor found in about 10% of the population. The odds of choroidal nevus developing into choroidal melanoma are about 1:8000 cases, however risk factors exist that increase these odds – visual symptoms (blurring of vision, flashes of light, floaters), subretinal fluid, orange pigmentation, tumor size of over 0.2mm and relative proximity to the optic nerve head.

Methods of treatment: Choroidal nevus cases require close observation by a specialist oncologist. Intraocular nevus can also develop in the iris and will also require an eye oncologist observation. The observation includes visual acuity test, full slit lamp examination, lesion ultrasound and other tests, including color imaging, OCT and additional tests per requirement.

2. Choroidal melanoma is the most common intraocular malignancy in old age. It’s a tumor that can spread metastases outside the eye, especially to the liver, while the odds of metastasis spread are directly proportional to the size of the melanoma. For this reason it is important to diagnose the malignant tumor at the earliest stage possible.

Methods of treatment: The treatment of choroidal melanoma is complex and usually involves radiation (plaque brachytherapy), laser therapy (for small tumors), or, in the advanced cases, enucleation (removal of the eye). In addition, a general oncologist observation is required for systemic evaluation.

3. Retinoblastoma is the most common children’s malignancy. Most cases occur up to the age of 5 years. The most common sign of the retinoblastoma is leucocorea, or “white pupil”, followed by strabismus. It is important in a case of a newly developed strabismus in a child to perform a full eye examination, including pupil expansion, to rule out retinoblastoma. The disease can appear in one eye or both eyes, can be inherited or develop in a baby with no family background. The diagnosis and treatment of the disease are complex and require a multidisciplinary team led by an expert oncologist.

Methods of treatment: The primary treatment for retinoblastoma includes administering chemotherapy in a number of ways (systemic or directly into the eye) in addition to localized treatments, which include laser, freezing and radiation (per requirement).

4. Other benign intraocular tumors include choroidal hemangioma, retinal hemangioma, choroidal osteoma, and other tumors. These tumors are not life-threatening, but, depending on their location, size and associated complications, can lead to vision impairment.

Methods of treatment: addressing these tumors requires observation and sometimes treatment by an expert eye oncologist.

– Surgery for removal of conjunctival lesion

– Cryotherapy

– Amniotic membrane implantation

– Pterygium + implant surgery

– Enucleation (eye removal surgery)

– Intraocular injections