Unlocking Eye Cancer: Types, Risk Factors, and Treatment Options

• Written by Mudit Handa

  Reviewed by Munmi Sharma

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In today’s digital and technologically advanced world, we are more susceptible to vision defects caused by harmful UV radiation. While most optical diseases are preventable, eye cancer is a particularly challenging and critical medical condition. Though relatively rare, Eye cancer in children has noticeable impacts in India. According to Dr Manas Kalra, senior paediatric oncologist at Sir Ganga Ram Hospital, over 5,000 new cases of Retinoblastoma are diagnosed worldwide every year. Of these, a third (over 1500) are diagnosed in India.

July is UV Safety Awareness Month, which focuses on raising awareness about the adverse effects of ultraviolet rays on vision. This July, it’s crucial to know about the risk factors associated with eye cancer and how to prevent them.

What is Eye Cancer?

Ocular cancer, a rare form, originates in the eye. It can involve various eye components, including the eyeball (including intraocular melanoma and lymphoma), surrounding tissues (adnexal tumours), and the optic nerve.

Ocular cancer occurs when malignant cells within or around the eye grow uncontrollably, forming a tumour. This condition can manifest in various forms and affect eye structures and surrounding tissues.

Various Types of Eye Cancer

Eye cancer can affect different parts of the eye and the surrounding tissue. Here are some key types of ocular cancer:

Intraocular Melanoma 

This is the most common primary eye cancer in adults. It originates in the uvea, the eye's middle layer that includes the iris (the coloured part), ciliary muscles that control the lens and produce fluid, and the choroid (a blood vessel layer that nourishes the retina). In rare cases, iris melanoma —a distinct type of melanoma— can also affect the iris. It usually grows slowly and is often detected early.

Retinoblastoma 

Retinoblastoma is the most common eye cancer in children. It originates in the retina, the light-sensitive tissue at the back of the eye. It can be both hereditary and non-hereditary, making family history one of the significant causes of eye cancer in children.

Intraocular Lymphoma

This rare form of non-Hodgkin lymphoma targets the eye. It may present as primary intraocular lymphoma, which originates in the eye, or as a secondary manifestation of lymphoma elsewhere in the body. It commonly affects the vitreous, the gel-like fluid inside the eye, and the retina.

Squamous Cell Carcinoma of the Conjunctiva

This cancer develops on the conjunctiva, the clear membrane covering the white of the eye and the inside of the eyelids. It is frequently associated with UV exposure and may look like benign growths.

Eyelid Carcinoma

These are common types of skin cancer that can develop on the eyelids. They can grow in two different ways: 

• Basal Cell Carcinoma:  The most common type of eyelid cancer, typically appearing as a persistent sore, lump, or red patch. 
• Squamous Cell Carcinoma: Less common but more aggressive than basal cell carcinoma.

Lacrimal Gland Tumours

These rare tumours affect the lacrimal glands, which produce tears. They can be benign (non-cancerous) or malignant (cancerous).

Orbital Tumours

These tumours occur in the orbit, the bony socket surrounding the eyeball. They can be primary (originating in the orbit) or secondary (spreading from another body part). They can affect muscles, nerves, and fat within the orbit.

Why Does Understanding Types of Eye Cancer Matter?

Identifying the specific type of eye cancer is essential for determining the most effective treatment plan. The rarity and complexity of these cancers often necessitate a multidisciplinary approach involving ophthalmologists, oncologists, radiation oncologists, and other specialists to provide comprehensive care.

For instance, the above image shows the development of a retinoblastoma, a prevalent type of eye cancer in children. The prognosis of this disease is just a tiny blind spot on the retina, which should be detected before it develops into a tumour. 

What Causes Eye Cancer?

Although the exact eye cancer causes are not fully understood, it is believed to result from a combination of genetic mutations and environmental factors. These mutations can lead to uncontrolled cell growth, which can result in the formation of a tumour. Additionally, direct exposure to the harmful UV radiation of sunlight can damage DNA and increase the risk of malignant growth in the eye.

Common Risk Factors for Ocular Cancer

Several factors can increase a person's risk of developing ocular cancer. These include:

• Age: The risk of most types of ocular cancer increases with age.
• Race: Ocular melanoma is more common in Caucasians.
• Fair skin and light eye colour: Individuals with fair skin, light-coloured eyes (blue, green, grey), and light hair have a higher risk of ocular melanoma, similar to skin melanoma.
• Excessive exposure to ultraviolet (UV) light: Prolonged exposure to sunlight, particularly UV-A and UV-B radiation, may increase the risk of certain types of ocular cancer; however, the link is weaker than with skin cancer.
• Certain genetic conditions: Some inherited conditions, such as BAP1 tumour predisposition syndrome, neurofibromatosis, and retinoblastoma (a type of eye cancer in children), can increase the risk of developing ocular cancer.
• Family history: A family history of ocular melanoma can slightly increase an individual's risk.
• Particular occupations: Jobs with high exposure to UV radiation or certain chemicals may contribute to a higher risk, although more research is needed.

What are the Symptoms of Eye Cancer?

Eye cancer symptoms can vary with cancer type and where it develops in the eye. Some people may experience no symptoms in the early stages of the disease. However, it's crucial to be aware of potential changes and consult a doctor if you notice any of the following:

• Vision changes may include blurry vision, flashes of light, floaters (spots or squiggly lines drifting across your sight), or a sudden loss of vision.
• A dark spot on the iris that grows over time is also a concern.
• Changes in the eye's appearance could involve an enlarging dark spot on the iris, a bulging eye, or alterations in the size or shape of the pupil.
• Intermittent pain in or around the eye can occur, especially if the tumour presses on nerves or other structures.
• Persistent redness or irritation of the eye.
• Lumps or growths on the eyelid or around the eye should also be evaluated.

Key Takeaways: Many of these symptoms may also be caused by milder conditions. However, if you notice any ongoing or concerning eye symptoms, it is essential to consult an ophthalmologist (an eye specialist) for a thorough examination. 

Eye Cancer Treatment Options

Treatment for ocular cancer depends on several factors, including the type and stage of the cancer, its location, the patient's overall health, and their preferences. Standard treatment options include:

Surgery 

The primary eye cancer treatment​ method is surgery. Two surgical techniques are commonly used to treat eye tumours:

• Enucleation: This procedure removes the entire eye. It is often necessary for large tumours or when vision cannot be preserved.
• Resection: This procedure involves removing the tumour and a small amount of surrounding healthy tissue. It is feasible for smaller tumours.

Radiation Therapy

The most advanced approach to eye cancer treatment​ is Radiation Therapy or Radiotherapy. It utilises a medical-grade radioactive beam to destroy malignant cell growth. Mainly, two kinds of radiotherapy techniques are used:

• Brachytherapy or Plaque Radiotherapy: A small radioactive disc (plaque) is temporarily sewn onto the outside of the eye over the tumour. The plaque delivers high doses of radiation directly to the tumour while minimising exposure to healthy tissues. This is a standard treatment for ocular melanoma.
• External Beam Radiation Therapy (EBRT): High-energy rays target and destroy cancer cells. This can include proton beam therapy.

Laser Therapy

Another powerful way to treat cancer cell growth in the eye is high-power medical-grade laser beams. Two types of laser therapies are commonly used for this purpose:

• Transpupillary Thermotherapy (TTT): Uses heat from a laser to destroy cancer cells in small tumours.
• Photocoagulation: A Laser beam seals the blood vessels that supply the tumour.

Chemotherapy

It is less commonly used for primary ocular cancers but may be used for certain types, such as lymphoma, or when the cancer has spread to other body parts.

Targeted Therapy

It is often used in combination with an advanced treatment approach. It uses drugs that target specific genes or proteins involved in cancer growth and is being explored for certain types of ocular cancer.

Immunotherapy

Immunotherapy is a newer approach, particularly used against metastatic ocular melanoma. It uses specialised drugs, such as immune checkpoint inhibitors and T cell engagers that naturally boost the body's immune system to fight eye cancer.

Key Takeaways: Early detection and diagnosis are key in effectively treating ocular cancer. Catching and identifying problems early can significantly improve treatment outcomes. 

How to Prevent Eye Cancer?

While it's not always possible to prevent eye cancer, several measures can be taken to reduce the risk, especially for certain types. Since UV radiation is the key cause behind eye cancer, staying protected from harmful radiation is always advisable.

• Protect Your Eyes from UV Radiation: Wear UV-blocking sunglasses (99-100% UVA/UVB blockage), even on cloudy days. Use wide-brimmed hats for added shade. Avoid direct sun exposure during peak hours (10 AM - 4 PM).
• Wearing Sunglasses: Polarised sunglasses are the best for checking UV radiation outdoors. You may also use UV protection in your contact lenses, but consider using sunglasses along with them.
• Regular Eye Examinations: Get comprehensive eye exams to detect early signs of eye conditions, including cancers. Inform your doctor about a family history of eye cancer (retinoblastoma, melanoma) for specialised screenings.
• Be Aware of Moles and Lesions: Monitor moles on and around your eyes for changes. Report suspicious moles to your doctor., You can examine your eyelids and visible eye parts for any unusual lumps or growths.
• Maintain a Healthy Lifestyle: Eat a balanced diet rich in fruits, vegetables, and antioxidants for overall eye health. Avoid smoking to reduce overall cancer risk, including ocular melanoma.
• Genetic Counselling (for Retinoblastoma): If you have a family history of retinoblastoma, consider seeking genetic counselling to assess the risk for children and guide screenings.
• Limit Exposure to Certain Chemicals: Follow safety guidelines if you work with hazardous substances known to increase cancer risk, including eye cancer.

These are practical ways to reduce the risk of eye cancer and protect your eye health. However, some eye cancers, especially those with genetic links, may not be entirely preventable. 

Fight the Fear of Eye Cancer with a Medical Insurance Plan

Preventive measures and regular eye check-ups can lower your risk and improve the chances of early detection if cancer develops. Along with a healthy lifestyle, it is essential to have advanced health coverage in the form of a Cancer Mediclaim at Care Health Insurance to cover various types of cancers, including eye cancer. It covers chemotherapy, radiotherapy, organ donation, second opinion, annual health check-up, quick recovery counselling and more. Remember that when selecting a medical insurance plan, it is crucial to review the waiting periods associated with various critical illnesses.

Disclaimer: It is essential to verify the policy details and coverage with the official policy documents. Also, kindly consult a professional medical expert to verify the details of your health concerns.