OCULAR TUMORS

In general, tumors are either benign (not cancerous) or malignant (cancerous). They may occur in different parts of the eye and cause varying visual effects depending on the specific location involved. Intraocular tumors may be found on a routine eye exam, or may cause vision problems prompting those affected to seek care. Frequently patients are referred to a Colorado Retina specialist to determine if suspicious ocular lesions should be observed or treated.

Benign tumors are not harmful to one's health, and may be observed when not affecting vision. Regular observation is recommended as some benign conditions may undergo “neoplastic transformation” to become malignant. Some types of benign tumors may be associated with systemic conditions and further testing may be needed. Examples of benign tumors include nevus, osteoma, hemangioma, congenital hypertrophy of the retinal pigment epithelium (CHRPE), and others.

Malignant tumors are associated with cancer and can affect the whole body. For some, the malignant tumor of the eye may be the first sign of systemic cancer. Malignant tumors may start in the eye, such as ocular melanoma. Other malignant tumors are metastases, which have spread to the eye from cancer in another part of the body, such as breast, lung, GI tract, prostate or other sources. Lymphoma may also evolve within the eye.

Most tumors will require periodic evaluations to monitor for change or evaluate response to treatment. The primary focus of the exam is to characterize the tumors in terms of size and shape and other qualities. Multiple imaging technologies are usually needed to create an accurate description of the tumor. This “multimodal” imaging can include specialized cameras, blood flow analysis, and ultrasound measurements. Due to the specialized testing needed exams may require two or three hours. Cancer patients will also require routine body imaging studies.

Treatment is designed to eradicate the tumor in the eye while preserving vision if possible. Fortunately, many treatment options are available including medications, injections, laser procedures, or even surgery. Benign tumors may be treated to improve vision. Malignant tumors are treated in coordination with other oncologists. Sometimes a biopsy is needed, requiring a trip to the operating room to obtain a tissue sample. Several types of lasers can be performed in the clinic, including, argon, photodynamic therapy (PDT), and diode transpupillary thermotherapy (TTT) to destroy tumor tissue. Radiation treatment (e.g. plaque brachytherapy) is also routinely performed by our team of ocular specialists at Colorado Retina. When it is not possible to save the eye, removal of the eye (enucleation) is offered. We often coordinate care with other physicians including eye doctors, oncologists, radiologists, and proton centers.

Side effects of radiation treatment applied to the eye may take years to develop and include cataracts, glaucoma, and radiation retinopathy, depending on the location and size of the tumor and the radiation dose used. Treatment of the side effects of radiation is possible, and for many it prolongs useful vision.