Ocular oncology refers to a specialised field in ophthalmology treatment relating to eye cancer. In other words, ocular oncology deals with the diagnosis of ocular tumours, their management, and treatment. Eye cancer can include tumours found on the eyelids, the outsides of the eyeball (such as the conjunctiva), the orbit (eye socket), and inside the eyeball itself.
Types of Tumours in Ocular Oncology
Ocular tumours management encompasses many different types of tumours. Some of these are benign, while others are obviously malignant. A tumour is a mass of cells that have grown out of control. These cells can also behave differently from normal cells. Instead of following the typical life cycle of a healthy cell, cancerous cells don’t die at the end of the normal lifespan but continue to multiply and spread through healthy tissue, a process known as metastasis. A malignant or cancerous tumour is one that invades other parts of the body, while a benign tumour is an abnormal growth without the potential to spread.
Tumours of the eyelid
Ocular oncology includes the ocular adnexa, which simply refers to the tissues surrounding the eye, such as the eyelids. There are a few different types of eyelid cancers:
- Basal cell carcinoma. This is the most common type of eyelid cancer, typically found on the lower eyelid as a result of sun exposure. People with pale complexions are at a higher risk of this type of skin cancer. About 90% of eyelid cancers requiring ocular tumours management are basal cell carcinomas.
- Squamous cell carcinoma. Squamous cell carcinomas are less commonly found compared to basal cell cancers but spread more aggressively. Around 10-30% of skin cancers arise from the squamous cell layer of the skin and are also usually associated with sun exposure.
- Sebaceous carcinoma. Within the eyelids are a number of sebaceous oil glands that produce oil to support various functions of the eye. However, these glands can develop malignant growths known as sebaceous carcinomas. Usually, the meibomian glands, which produce the oily layer of the tear film of the upper eyelid, are involved.
- Melanoma. Similar to other areas of the body, the eyelids can develop tumours of the pigmented cells in the skin called melanocytes. Melanoma can arise on its own or develop from a pre-existing skin naevus (a pigmented spot similar to a freckle). UV exposure is the main cause of melanomas of the skin.
Ocular oncology cases involving the eyelid usually require specialist ophthalmology treatment with an oculoplastic surgeon. An oculoplastic specialist is one who specialises in the eyelids and structures surrounding the eyeball. A plastic surgeon may also be able to provide ocular tumours management for eyelid growths.
Tumours of the eyeball
In ocular oncology, there are only two types of primary tumours that occur within the eyeball itself – retinoblastoma in paediatric patients or ocular melanomas in adults. A primary tumour is one that grows by itself rather than having spread from another cancer site. Fortunately, primary intraocular tumours in ocular oncology are rare.
Retinoblastomas begin in the retina of the eye, the light-sensing layer of cells lining the inside of the eyeball. In children under five years old, it’s the most common cancer requiring ophthalmology treatment. Retinoblastoma is not apparent in its early stages. However, as the tumour develops, you may notice signs in your child such as:
- Reports of eye pain
- A turned eye (lazy eye)
- A white or yellow glint in the pupil (the hole in the middle of the colour iris)
- Redness and swelling of the eye
Ocular melanoma affects around 1 in 5 million adults globally every year. Like melanoma of the eyelid, ocular melanoma arises from the pigment cells inside the eyeball. Ophthalmology treatment for ocular melanomas is often delayed because of the difficulty in detecting this disease. The cancer is typically asymptomatic until the tumour has grown significantly. At this stage, you may notice:
- Flashing lights as the tumour disturb the retina
- Changes in the shape or appearance of your pupil if the tumour invades the iris
- Blurred, distorted sight, or patches missing from your field of view
Ophthalmology treatment for ocular melanoma inside the eyeball may be with radiation therapy or surgery.
Tumours of the conjunctiva
The conjunctiva is the translucent membrane covering the whites of the eyeball. Quite a number of different growths can be found in this tissue, and some are very common. Ocular oncology requires differentiating those growths between benign tumours and malignant cancers.
Cancerous growths can include ocular surface squamous neoplasia, primary acquired melanosis, squamous cell carcinoma, and melanoma of the conjunctiva. However, harmless growths are very commonly found on the conjunctiva, too. The most common of these are pingueculae, pterygia, and naevi. Ophthalmology treatment of malignant conjunctival growths can include chemotherapy, surgery, or radiotherapy.
Ocular oncology is a highly specialised field in ophthalmology. Any bumps or spots on your eye or eyelid should be monitored carefully. If you notice any changes to an existing growth, such as an increase in size, bleeding or ulceration, or flakiness to the skin, see your eyecare professional without delay.
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Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
Inside the clinical speciality of ocular oncology – Insight
Ocular Oncology – optometrists.org
Eyelid Cancer: Overview
Basal Cell Carcinoma – EyeWiki
A Guide to Conjunctival Tumours – Review of Optometry