People may not show visible symptoms

By Troy Bedinghaus, OD 

 Medically reviewed by Johnstone M. Kim, MD

Eye tumors are also called ocular tumors. An eye tumor can be cancerous or noncancerous. About 3,490 new eye cancers are estimated to be diagnosed in 2023.¹

Symptoms of eye tumors can include vision changes, pain, and changes in the shape and movement of the eye.

This article will go over the different types of eye tumors. It will also discuss eye tumor symptoms, how eye tumors are diagnosed, and the various options for treating them.

DermNet / CC BY-NC-ND

Cancerous Eye Tumors

Cancerous tumors are called malignant tumors. Malignant eye tumors can be either primary or secondary. A primary tumor is one that begins in the eye. A secondary tumor is caused by cancer that has spread from one part of the body to another.

There are several types of cancers that can affect the eyes. Orbital cancers affect the tissues around the eyeball. The muscles that move the eyeball and the nerves attached to the eyeball can also be affected.

Cancer can also form in the eyelids and tear glands. Cancers that affect these structures are called adnexal cancers.²

Primary Eye Tumors

Primary eye tumors are rare. In adults, the most common type is ocular melanoma.³ This tumor is also called uveal melanoma or choroidal melanoma.

Malignant melanomas usually form from simple moles. That's why it's important to check moles often for changes. If you have a mole in or near your eye, have it examined regularly.

Ocular melanomas form from cells in the eye that give them color. These are called pigmented cells. This type of tumor happens in the three main parts of the eye:

• The iris, or the colored part of the eye

• The choroid, which is located between the retina and the white outer part of the eyeball. Most eye melanomas form in the choroid.⁴

• The ciliary body, which connects the iris to the choroid

Less common types of primary eye tumors include:⁵

• Intraocular lymphoma, a rare type of lymphoma that starts in the eyeball

• Retinoblastoma, a cancer that starts in cells in the retina (the light-sensing cells in the back of the eye). This type of cancer is more likely to affect children than adults.

Rare cancers of the eye include:⁶

• Conjunctival melanoma, a type of cancer that affects the conjunctiva, a thin clear covering over the sclera, or the whites of your eye

• Eyelid carcinoma, a type of basal cell carcinoma (skin cancer) that affects the skin of the eyelid

• Lacrimal gland tumors, which occur in the tear glands

Secondary Eye Tumors

The most common type of cancerous eye tumor is metastatic, or secondary. This means the cancer originated in another area of the body and spread to the eye.

Secondary eye tumors are most often found in the choroid. In women, they most commonly originate as breast cancer.³

In males, lung cancer is the most common cause.³ Other types of cancer that can lead to secondary eye tumors include kidney, thyroid, prostate, and cancers of the gastrointestinal tract.⁷

Non-Cancerous Eye Tumors

If you've been diagnosed with an eye tumor, cancer may be your first concern. Not all eye tumors are cancerous, however.

Choroidal hemangioma is the most common type of noncancerous eye tumor. These tumors are made up of blood vessels.⁸ They can cause eye redness or vision changes. Benign tumors can also grow in the skin around the eye or on the eyelid. Benign eye tumors may also show up on the conjunctiva.

Benign, pigmented lesions can grow on the inner part of the eye. These are called choroidal nevi. Because they grow inside the eye, they can usually only be seen using special equipment.

A spot on the eye that looks like a freckle could be congenital hypertrophy of the retinal pigment epithelial layer (CHRPE). These growths are a bunch of pigmented cells that look dark. Most are benign.

Having one or two CHRPE lesions is usually not concerning. However, having multiple CHRPE lesions has been linked to a genetic condition called familial adenomatous polyposis (FAP).

FAP is caused by a mutation in a gene that usually suppresses tumors. People with FAP will also develop large numbers of polyps in the large intestine. These polyps are at high risk for developing into colorectal cancer.⁹

How Serious Are Eye Tumors?

The prognosis for eye cancer depends on the location of the tumor, the type of cancer, and whether it is confined to the eye or has spread to surrounding tissues or distant organs. The overall five-year relative survival rate for all types and stages of eye cancer is 81%.¹⁰ This means that people with eye cancer are, on average, 81% as likely as people who don’t have this cancer to live for at least five years after being diagnosed.

Eye Tumor Symptoms

Like skin moles, eye moles form when certain cells grow together in a group. At first, you may see an abnormal brown spot on or in your eye. This is called a nevus. These moles usually form on the choroid, iris, or conjunctiva of the eye.

An eye tumor may look like a dark spot on the colored part of your eye called the iris. If you notice a spot in your eye, tell your healthcare provider.

Eye tumors don't always have symptoms. When they do, symptoms can include:⁵

• Light sensitivity

• Lumps on the eyelid or other parts of the eye

• Changes in the shape of the pupil

• Bulging, redness, or swelling of the eye

• Changes in the way the eye moves

• Eye pain

• Visual distortion

• Blurry vision

• Loss of vision

• Floating objects in vision (floaters)

• Glaucoma¹¹

Eye melanomas are often found during routine exams.³ That's why having regular eye exams is important. If your healthcare provider thinks you are at higher risk for eye melanoma, they might recommend that you have an eye exam every year.

Detecting cancer early means you'll have more treatment options. That said, not all cancers of the eye can be found early.

What Causes Eye Tumors?

Eye tumors can have different causes. The causes of eye tumors that are not cancerous are different from those that are.

Benign Eye Tumors

Benign eye tumors can have a number of causes:

• Hemangiomas are caused by an abnormal growth of blood vessels in or around the eye.

• Benign tumors and growths on the skin around the eye, eyelid, and conjunctiva are commonly caused by exposure to wind and ultraviolet rays from the sun.

• Growths in the eye that show up suddenly are usually caused by infections and inflammation. Some might be caused by a virus.

• Eye changes from aging can also cause eye growths to appear.

• Large pigmented lesions or moles can be genetic. They can also be related to a medical condition.

Malignant Eye Tumors

Cancer happens when there are changes to DNA inside cells. These changes are called mutations. The DNA in a cell has a set of instructions that tell the cell what functions to perform. It also tells it how to grow and divide. If there are errors in the instructions, the cell may not function right. When this happens, the cell can become cancerous.

Several factors contribute to genetic mutations. These include inherited gene mutations and gene mutations that happen after birth. You might be born with a genetic mutation. Some mutations are passed down through families. This is called inheritance. An inherited mutation only causes a small number of eye cancers.

Most gene mutations occur after you're born. Many things can cause gene mutations, such as:

• Smoking

• Radiation exposure

• Viruses

• Carcinogens

• Obesity

• Hormones

• Chronic inflammation

• Lack of exercise

Eye Cancer Risk Factors

Certain factors can put you at greater risk for developing eye cancer. Some of these risk factors, like your age and family history, are things you can't control. Other risk factors can be reduced, like exposure to ultraviolet rays.

Age and Race

Primary intraocular melanoma usually happens to people over the age of 50. The average age that a person is diagnosed is 55. This type of eye cancer is rare in children and people older than 70.¹²

Primary intraocular melanoma is more common in white people than Black people. Men and women are equally affected by this type of eye cancer.

Medical History

Basal cell carcinoma, squamous carcinoma, sebaceous carcinoma, and malignant melanoma are all types of eyelid cancers. There are several factors that make a person more likely to get intraocular melanoma, including:

• Extra pigmentation of the eye or skin around the eye

• Spots like moles in the eye

• Multiple flat moles that are irregular in shape or color¹³

Family History

Intraocular melanoma can run in families. It usually happens because of a gene mutation.

Eye tumors in children are uncommon, but a rare type of cancer called retinoblastoma can affect children under the age of five. It is caused by a genetic mutation. and starts in the light-sensitive tissue lining the back of the eye.¹⁴ This part is called the retina. The retinal nerve cells begin to grow and multiply. They usually spread into the eye and possibly to other parts of the body.

If caught early, these childhood eye tumors may be curable. In fact, nine out of 10 children with retinoblastoma will be cancer free five years after treatment.¹⁵

If you have risk factors associated with cancer of the eye, you should see a doctor who is an expert in eye health (ophthalmologist) every year for an exam. Also, tell them if you ever see an unusual mole or skin growth around your eye.

Ultraviolet Rays

Sunlight may increase your risk of intraocular melanoma, though the science on this is still unclear.¹⁶You can help reduce your risk by wearing sunglasses that block ultraviolet rays.

Diagnosis

Eye tumors are often found by an optometrist. An ophthalmologist can usually tell the difference between tumors that are cancer and those that are not.

If the growth is on your skin, you might also work with a healthcare provider who is a skin health expert (dermatologist).

If your provider is concerned about a growth near your eye, they might cut a small piece off to send to a lab to be looked at more closely. This is called excision.

An expert called a pathologist can look at the sample of your skin and tell if it has cancer. They will send a report to your provider explaining what they find.

Eye care providers can also take a digital picture of the growth in your eye. This allows them to watch it closely to see if it changes over time.

Sometimes, eye care providers will do an ultrasound of the tumor. This can help them tell certain things about the growth, like how solid it is. This information can help them tell whether a growth might be cancer or not.

Benign growths inside the eye usually have easy-to-see edges called margins. They are typically flat or slightly raised. Malignant growths tend to have irregular shapes and color changes. They may also have fluid on top of them.

Your healthcare provider can use different tests and tools to check you for eye cancer:

• Eye exam: Your practitioner will look closely at your eyes. They will look at the outside and the inside of both eyes and check for specific things. For example, having larger than normal blood vessels on the outside of your eye is usually a sign of a tumor inside your eye. Your healthcare provider can also look deep inside your eye using a tool called a binocular indirect ophthalmoscope (BIO). This instrument uses lenses and a bright light to see inside the eye. A slit lamp can also look at the structures in your eye.

• Eye ultrasound: An eye ultrasound produces images of the inside of your eye. The ultrasound wand is placed on your closed eyelid or near the front surface of your eye.

• Optical coherence tomography (OCT): OCT is an imaging test that creates pictures of the inside of your eye.

• Fluorescein angiography: For this procedure, a dye called fluorescein is injected into your arm. The dye "lights up" structures as it is moving through your body into the blood vessels in the back of your eye. This makes it easier for your provider to take pictures of your eye.

• Fine needle biopsy: During this procedure, your provider will take tumor cells out of your eye using a needle. The cells will then be looked at under a microscope. This procedure is not usually needed; in most cases, eye melanoma can be diagnosed without a biopsy.

• Other imaging tests: If you are diagnosed with eye cancer, your provider might need to do imaging tests on the rest of your body to see if the eye cancer has spread anywhere else.

If it is suspected that eye cancer is a secondary cancer, tests will be done to locate the source of the original tumor site (such as the lungs).

Treatment

The treatment for an eye tumor will depend on whether it is cancerous or not.

Benign Eye Tumors

Benign growths that are on the outside of the eye can be taken off surgically. Some can be removed with chemicals or burning (called cauterization).¹⁷

Honavar SG, Manjandavida FP. Tumors of the ocular surface: A review. Indian J Ophthalmol. 2015;63(3):187-203. doi:10.4103/0301-4738.156912

If freckles and growths inside the eye are benign, they are usually left alone. However, you will need to have them examined every six to 12 months to make sure they don't change.

Eye Cancer

The goal of treating eye cancer is to make it less likely to spread. It's also important to maintain your vision, if possible.

The treatment options for eye cancer depend on several factors, including the type and stage of cancer, the possible side effects, and your overall health.

People with eye cancer are often treated by several doctors who use different treatments. This is called a multidisciplinary approach. Your treatment team will try to save your vision whenever possible.

The way eye cancer is treated will depend on the tumor and whether cancer has spread to other areas of the body. Here are a few things that might be part of a treatment plan for eye cancer:³

• Radiation therapy: Radiation therapy destroys cancer cells with high-powered energy beams. This is the most commonly used treatment for most eye cancers. You will have a specific number of radiation treatments over a set time.

• Laser therapy: Laser therapy uses lasers to shrink tumors. This treatment usually has fewer side effects than surgery or radiation therapy.¹⁸

• Immunotherapy: Immunotherapy medications stimulate the body’s own immune system to recognize and attack cancer cells.

• Targeted therapy: Targeted therapies include several drugs that target certain proteins in genes that can cause ocular melanoma. Targeted therapies called BRAF inhibitors (commonly used for eye melanoma) include vemurafenib and dabrafenib.

• Chemotherapy: If uveal melanoma has spread to other parts of the body, chemotherapy may be necessary to kill cancer cells in those areas. Chemotherapy drugs used to treat uveal melanoma are usually the same as those used to treat melanoma of the skin.

• Surgery: If you have a cancerous eye tumor, surgery may be necessary. During surgery, your ophthalmologist may take out parts of your eye. This will depend on how big the tumor is and whether it has spread.

• Eye removal: In some cases, the only choice for treatment is to remove the eye. The loss of vision will affect your depth perception, but many people adjust to the vision changes.

Summary

Growths in or near the eye are not always cancer. If the growth is benign, your healthcare provider might remove it. They might also leave it alone and just check it regularly to make sure it doesn't change.

If you are diagnosed with eye cancer, you will have different treatment options, including chemotherapy, radiation, and targeted therapies. Your oncology team will make every effort to preserve your vision.

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By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.