Eye Cancer

Overview

Eye cancer means cells in or around the eye start to grow out of control. There are two main kinds. 'Primary' eye cancer starts in the eye itself. The most common primary eye cancer in adults is uveal melanoma, which begins in the uvea — the middle layer of the eye that contains pigment cells and blood vessels. In children, the most common is retinoblastoma, a cancer that starts in the light-sensing part of the eye (the retina). 'Secondary' eye cancer means cancer that started somewhere else in the body, such as the breast or lung, and has spread to the eye. Cancers can also start on the surface of the eye, in the thin clear skin covering it (the conjunctiva), or on the eyelid. Each type behaves differently and is treated differently.

No, eye cancer is rare. Uveal melanoma affects roughly 5 to 6 people in every million each year in the UK. Retinoblastoma is even rarer, affecting about 1 in every 15,000 to 20,000 babies born. Because it is rare, most people who have eye symptoms do not have cancer — but it is still worth getting checked.

Uveal melanoma is most often found in adults in their 50s and 60s, and is more common in people with light-coloured eyes and fair skin. Retinoblastoma almost always affects young children, usually under the age of 5. Cancers of the eye surface and eyelid are more common in older adults and in people who spend a lot of time in strong sunlight, or whose immune system is weakened. Some rare inherited gene changes can raise the risk in families.

Symptoms

Common symptoms

• Blurred vision or a change in eyesight that does not get better with glasses
• Seeing flashes of light or new floaters (small specks or squiggles drifting in your view)
• A dark shadow or 'curtain' across part of your vision
• A dark spot on the coloured part of the eye (the iris) that is new or growing
• A visible lump or fleshy patch on the white of the eye or on the eyelid
• A red, watery or irritated eye that does not settle
• An eye that looks like it is bulging or being pushed forward
• Loss of some or all vision in one eye
• Sometimes no symptoms at all — some eye cancers are found during a routine eye test

Symptoms in children

• A white, yellow or glowing pupil seen in photos, especially when using a camera flash (often called the 'cat's eye' reflex)
• One eye turning inwards or outwards (a squint)
• A red, swollen or sore-looking eye that does not improve
• Not seeming to see well, or not following objects or faces
• A pupil that looks different from the other side
• Sometimes the eye looks slightly larger than usual

Symptoms in older adults

• Changes in vision that are put down to 'just getting older' but keep getting worse
• New floaters or flashes, which can also be caused by a detached retina — this needs urgent checking
• A growing lump or sore on the eyelid that bleeds or does not heal
• A persistent red or gritty eye, or a spot on the white of the eye
• Watery or irritated eyes with no clear cause

Causes

Main causes

• Uveal melanoma happens when pigment cells inside the eye develop gene changes that let them grow out of control. In most people there is no obvious reason why this happens.
• Retinoblastoma is caused by changes in a gene called RB1, which normally stops cells growing too fast. These changes can happen by chance, or be inherited from a parent.
• Some eye cancers are lymphomas, which start in immune system cells and can appear in or around the eye.
• Cancers on the surface of the eye or eyelid are often linked to long-term sun (ultraviolet) exposure, and sometimes to a weakened immune system.
• Sometimes cancer from elsewhere in the body spreads to the eye, which is called secondary eye cancer.

Risk factors

• Light-coloured eyes (blue, green or grey) and fair skin
• Older age, especially for uveal melanoma and eyelid cancers
• A lot of unprotected exposure to strong sunlight or UV light over the years
• Rare inherited gene changes, such as changes in BAP1 or other genes linked to melanoma
• A family history of retinoblastoma, or a known RB1 gene change
• A weakened immune system, or long-term use of medicines that suppress it
• Having many unusual moles or a previous melanoma of the skin
• Certain rare inherited conditions that affect growth and development

When to see a doctor

See a doctor urgently if:

• You have sudden new floaters, flashes, or a shadow across your vision — get your eyes checked the same day
• You notice a new dark spot on the iris, or a spot on the eye that is growing
• A lump on your eyelid or eye is getting bigger, bleeds, or has not healed after a few weeks
• You have vision loss that is getting worse over days
• Your child has a white or glowing pupil in photos, or has developed a squint

Book a routine appointment if:

• Your vision has slowly changed and new glasses have not helped
• You have a red, watery or gritty eye that has lasted more than a few weeks
• You have noticed something that looks different about your eye and want it checked
• You have a strong family history of eye cancer, retinoblastoma, or melanoma

Diagnosis

An eye doctor (ophthalmologist) will usually start by asking about your symptoms, your general health and your family history, then look closely at your eyes. They use special drops to widen (dilate) your pupil so they can see the inside of your eye clearly. If they find something that needs more investigation, they will arrange scans and sometimes blood tests. Most eye cancers can be diagnosed with an eye exam and scans, without needing a biopsy (a small tissue sample). If a biopsy is needed, it is done carefully by a specialist.

Tests that may be done

• A detailed eye examination with a bright light and magnifying lenses
• Eye drops to widen the pupil so the back of the eye can be seen
• Photographs of the inside of the eye to track any changes over time
• Ultrasound scan of the eye, which uses sound waves and is painless
• Optical coherence tomography (OCT) — a quick, painless scan that takes detailed pictures of the eye
• CT or MRI scans to see the size of the cancer and whether it has spread
• A liver ultrasound or liver scans, because uveal melanoma most often spreads to the liver if it spreads at all
• Blood tests to check your general health
• Genetic testing in some cases, especially for children with retinoblastoma or adults with certain melanoma-related gene changes
• A biopsy (small tissue sample) in some situations, such as when lymphoma is suspected

What to expect at your appointment

Being referred for eye tests can feel worrying, and waiting for results is often the hardest part. The tests themselves are usually quick and painless, though the dilating drops can blur your vision and make bright light uncomfortable for a few hours — so it helps to arrange a lift home. You may need more than one appointment, and results can take a week or two. It is a good idea to bring someone with you, write down your questions beforehand, and ask your care team to explain anything that is unclear. Nothing will be done without your consent.

Treatment

Treatment depends on the type of eye cancer, its size, exactly where it is in the eye, and whether it has spread. Some small cancers are simply watched closely with regular scans, because they may never cause a problem. Others are treated to protect vision and stop the cancer growing. A specialist team including eye doctors and cancer doctors will discuss the options with you and explain the benefits and risks of each.

Self-care at home

• Go to all your appointments and follow-up scans, even when you feel completely well
• Use any eye drops your care team prescribes exactly as they explain
• Protect your eyes from strong sunlight with sunglasses and a hat
• Keep a simple diary of any changes in your vision and share it with your team
• Tell your team straight away about any new symptoms, especially changes in vision
• Ask for written information about your type of cancer so you can read it calmly at home
• Let family or friends help with travel to appointments and with practical tasks
• Be gentle with yourself — rest when you need to, and ask for emotional support early

Medical treatments

Treatment approaches include careful monitoring with regular scans; radiation therapy, which uses focused beams to kill cancer cells while aiming to spare healthy tissue (this can be given by placing a small radioactive patch on the eye for a few days, or by a precise external beam such as proton therapy); laser therapy, which uses heat or light to destroy small tumours; freezing treatment (cryotherapy) for some surface tumours; and chemotherapy for certain cancers, especially retinoblastoma in children, given by a specialist cancer team. For cancers that have spread, or certain types such as lymphoma, specialist cancer doctors may use treatments that work throughout the body, such as chemotherapy, targeted therapy or immunotherapy. Your team will explain which approach suits your situation, what it involves, and what the side effects may be.

When is surgery considered?

Surgery may be recommended if a tumour is large, causing problems, or not responding to other treatment. This can range from removing a small tumour or a patch of tissue, to removing the eye itself (called enucleation) when this is the safest option. If an eye is removed, an artificial eye (prosthetic eye) can be fitted later, and it is usually very hard for other people to tell. Surgery may also be used for cancers of the eyelid or eye surface. Your surgeon will explain exactly what is planned, what recovery involves, and how it may affect your vision.

Living with this condition

Many people with eye cancer carry on with work, family life and hobbies, with some adjustments. If your vision has changed, things like reading, driving, cooking and using screens may need small changes — an eye clinic or low-vision service can suggest practical aids and lighting. If you have an artificial eye, you will be shown how to clean and look after it. You will have regular follow-up appointments, which some people find reassuring and others find anxious-making; both reactions are normal. Tell your team how you are feeling, not just about your eye.

Lifestyle tips

• Wear sunglasses that block UV light when you are outdoors, especially in bright sun
• Keep up your normal routine as much as you feel able — gentle activity helps mood and sleep
• Avoid smoking, and cut down on alcohol if you drink, as this supports your general health
• Keep a list of your medicines and appointments in one place
• Ask about low-vision support, magnifiers or screen settings if reading becomes harder
• Tell your employer or school about your appointments so you can plan time off
• Check with your care team before starting new exercise or travel plans

Diet and exercise

There is no special diet that treats eye cancer, but eating regularly and well — plenty of vegetables, fruit, beans, wholegrains and protein — helps you cope with treatment and recover better. Drink enough water, and limit very salty and highly processed foods. Gentle, regular movement such as walking, swimming or stretching is good for energy, mood and sleep; build up slowly and follow any advice from your team. If treatment has affected your appetite or weight, ask to see a dietitian — this is a normal part of care.

Mental health and emotional wellbeing

Being told you or your child has eye cancer is a shock, and it is completely normal to feel scared, angry, numb or tearful at times. Waiting for scans can bring strong anxiety, and some people find they worry about their sight or about the cancer coming back long after treatment ends. These feelings usually ease with time and support, but they deserve attention. Talk to your GP or care team if low mood, worry or sleep problems are lasting more than a couple of weeks or affecting daily life — talking therapies and support groups help many people. If at any point you have thoughts of harming yourself, please reach out straight away: contact your local emergency number, your local crisis line, or a trusted person who can stay with you.

Prevention

Most eye cancers cannot be prevented, because no clear avoidable cause is known and they are linked to gene changes that happen by chance. There is no proven way to stop uveal melanoma from forming. You can still lower your overall risk by protecting your eyes and skin from strong sunlight with sunglasses and a hat, not smoking, and attending regular eye tests if you have a family history or an inherited gene change. If retinoblastoma or a melanoma-related gene change runs in your family, genetic counselling can help you understand the risks and the options for early checking.

Screening programmes

There is no national screening programme for eye cancer, because it is too rare for screening to be worthwhile for everyone. However, targeted checks are offered in some situations: children with a family history of retinoblastoma are usually checked soon after birth and regularly in early childhood, and people with certain inherited gene changes are offered regular eye and skin checks. After treatment for eye cancer, you will be offered regular follow-up scans — these are important even when you feel well. Always feel free to ask your optician or GP if you are unsure whether you should be checked.

Complications

If left untreated

• Gradual loss of vision, which may become permanent
• The cancer growing larger and pressing on structures inside the eye
• Raised pressure inside the eye (glaucoma), which can be painful and damage sight
• Spread of the cancer beyond the eye, most often to the liver for uveal melanoma
• In some cases, loss of the eye itself
• Rarely, serious illness if a fast-growing cancer is not treated

Long-term outlook

The outlook for eye cancer is often good, especially when it is found and treated early. Many small eye melanomas are treated successfully and keep useful vision, and retinoblastoma in children has a high cure rate in countries with good specialist care. Some eye melanomas can come back or spread years later, which is why follow-up checks and liver scans matter — they are there to catch any change early, when treatment works best. Newer treatments are also improving options for people whose cancer has spread. Knowing your own situation from your specialist team is the best guide, and it is always okay to ask them to explain what your results mean.

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