Treatment options for eye cancer

A team of healthcare professionals discuss your treatment options.

The most common treatments for eye cancers are:

surgery
radiotherapy
chemotherapy

You may also have other treatments that your eye specialist will discuss with you.

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are the multidisciplinary team (MDT). Your MDT might include:

Ophthalmologist

An ophthalmologist (pronounced op-thal-mol-o-gist) is a specialist eye doctor or surgeon. They treat conditions of the eye.

Oncologist

An oncologist is a doctor who specialises in treating cancer. This is most often with radiotherapy (clinical oncologist) or drug treatments such as chemotherapy or immunotherapy (medical oncologist).

Ocular oncologist

An ocular oncologist is a doctor who specialises in treating cancers of the eye.

Ophthalmology clinical nurse specialist

An ophthalmology clinical nurse specialist is a qualified nurse who has specialist knowledge of cancers of the eye. They organise your care between the eye specialists and other health professionals. A specialist nurse will also help to support you through your treatment. They will make sure you have the information you need.

Ocular prosthetist or oculist

An ocular prosthetist or oculist is a trained eye specialist who designs, makes and fits artificial eyes.

Pathologist

An expert who examines any cancer or tissue removed by a surgeon.

Other health professionals

Other health professionals who may help and support you include:

a counsellor
an occupational therapist
a social worker
an MDT coordinator
a research nurse

Your treatment for eye cancer depends on:

the type of eye cancer you have and where it is in the eye
the size of your cancer and how far it has grown or spread (the stage)
your general health and level of fitness

Your local hospital may refer you to a dedicated eye cancer unit. This is also called an ocular oncology unit. The units have a specialist multidisciplinary team for eye cancers.

There are 4 specialist units in the UK, based in:

Liverpool
London
Sheffield
Glasgow

If you are concerned that your treatment is not under a multidisciplinary team, do ask about it. It may be that you have only seen one specialist, but the team has still got together. They may have already discussed your test results and case notes to decide the best treatment options for you.

If you are having check ups, you may be under a system of shared care. This is when you have appointments at the specialist centre and also with the ophthalmologist at your local hospital.

Melanoma of the eyeball

Melanoma starting in the eyeball is rare. Uveal melanoma is the most common type of eye melanoma.

The uvea is the middle layer of the eye and has 3 parts:

iris (the coloured part)
ciliary body
choroid

Your treatment depends on:

where the cancer is
the size of the cancer
how much it is affecting your sight

If the cancer is large or already stopping you from seeing out of the eye, you will probably have surgery to remove the eye. This operation is called an enucleation.

It can come as quite a shock if you need to have surgery to remove your eye. You will need time to come to terms with this change. As long as you have sight in one eye, it may not make much to what you can and can’t do. You may still be able to drive, for instance.

It may help to know that many people who have had this surgery rate their quality of life as highly as people who have kept their eye.

Other treatments for the primary cancer Open a glossary item include:

radiotherapy
phototherapy
an operation to just remove the cancer (but not the eye)

Ask your doctor as many questions as you need to. Together you can decide which treatment is best for you.

Melanoma of the iris

This type of cancer can be so slow growing and may not always need treatment, especially if you don’t have symptoms. Your doctor will give you regular check ups to make sure the cancer is not getting bigger.

If the cancer grows, or if it is causing symptoms, you may have one of the following:

removal of the melanoma
removal of the whole eye (an enucleation)
radiotherapy, such as brachytherapy

Choroid or ciliary body melanoma

If melanoma of the choroid or ciliary body is not getting bigger you may not need treatment straight away. You will have regular check ups to make sure the tumour has not started to grow. This is sometimes called periodic observation.

If you do need treatment you might have one of the following:

radiotherapy, including brachytherapy or external beam radiotherapy
transpupillary thermotherapy
photodynamic therapy
surgery to remove just the cancer
surgery to remove the whole eye (enucleation)

Transpupillary thermotherapy and photodynamic therapy are types of laser therapy. They use a source of heat or light to destroy the cancer cells.

Your eye specialist will discuss the treatment choices with you. This usually depends on the size of the cancer.

Recurrent eye melanoma

If the cancer has come back in your eyeball (intraocular) you will most likely have surgery to remove your eye (enucleation). You may also have radiotherapy after surgery to kill off any cancer cells left behind.

Melanomas that have spread outside the eye

If your cancer has spread outside the eyeball, for example, to the optic nerve or the eye socket, it is called an extraocular melanoma. Your doctor might also call this extraocular extension. Unfortunately, you will probably need surgery to remove your eye and some of the surrounding tissue. This makes sure all the cancer is gone. You might also have radiotherapy.

If your uveal melanoma tested positive for human leukocyte antigen (HLA)-A*02:01, you may have a type of immunotherapy called tebentafusp. HLA-A*02:01 is an antigen on the surface of some types of cancer cells, such as melanoma cells. Tebentafusp is for people whose uveal melanoma can’t be removed with surgery, or that has spread to other parts of the body.

If your cancer has spread to the liver, it is called liver secondaries or metastases.

You might be able to have an operation to remove the cancer in the liver if it is only affecting a small area. It is sometimes possible to have treatment directly into the liver. It is important to remember that these treatments may only be suitable for a few people. Your specialist will explain if these treatments are right for you.

They include:

radiofrequency ablation
hepatic artery infusion
transarterial chemoembolisation
selective internal radiotherapy (SIRT)

You may also have treatment as part of a trial if your cancer has come back or spread. Because eye melanoma is rare, there are fewer trials available for people to join.

Lymphoma of the eye

Treatment for lymphoma of the eye depends on the type of lymphoma and if it has spread. It is treated in a similar way to other types of non-Hodgkin lymphoma. You may have radiotherapy, chemotherapy or both. You would not usually have surgery to treat lymphoma that develops inside the eye (intraocular lymphoma).

Radiotherapy

Your doctor may suggest external radiotherapy to your eye and brain. This can get rid of the cancer in the eye and also help stop it coming back in the brain or spinal cord.

Chemotherapy and targeted drugs

Most people with lymphoma of the eye will have chemotherapy. You usually have this through a drip into your vein.

You may also have chemotherapy injected into the fluid around your spinal cord (intrathecal chemotherapy). You might have this with radiotherapy. Some people have chemotherapy put into their eye (intravitreal chemotherapy). This is more likely for lymphoma that has only come back in the eye.

For some types of non-Hodgkin lymphoma, you have targeted cancer drugs. You might these drugs through a drip into your vein or as tablets.

Squamous cell cancer of the conjunctiva

Squamous cells are flat and cover many surfaces in the body. Most squamous cell cancers are found on the skin. But they can develop in other parts of the body including the conjunctiva in the eye.

The conjunctiva is the clear, moist membrane that covers the front of the eye and lines the inside of the eyelid. Although rare, squamous cell cancer is the most common cancer of the conjunctiva. This cancer is generally slow growing (low grade), and very rarely spreads to other parts of the body.

Treatment includes:

surgery to remove the cancer
freezing therapy (cryotherapy)
chemotherapy eye drops (topical chemotherapy)

Basal cell cancer and squamous cell skin cancer around the eye

Basal cell cancer and squamous cell cancer are types of skin cancer that can be found on the skin. They may be found on the eyelid. You may have one of the following treatments:

surgery
cryosurgery
creams to put directly onto the skin
radiotherapy
photodynamic therapy (treatment using a light sensitising drug and a very bright light)

Retinoblastoma

Retinoblastoma most commonly affects children under the age of 5. Because it is so rare it is treated in specialist centres. Your eye specialist will explain the best treatment and what is involved.

Treatment options depend on stage and size and may include the following:

cryotherapy (freezing therapy)
laser therapy
chemotherapy
surgery
radiotherapy

Your eye specialist will always explain why a specific treatment is best for your child. And you can always ask questions if treatment decisions are not clear.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.