Although no medical study till date have found clear evidences supporting the link between eye melanoma/lymphoma and ultraviolet rays, it is widely believed that too much sun exposure can cause these eye cancer types. Thus, to prevent eye cancer, you must wear sunglasses while going out in the sun. The sunglasses worn by you must be able to block both UVB and UVA rays. According to the regulations set by the US government, the sunglasses must be able to block 95% UVB rays and 99% UVA rays. For maximum effects opt for the wraparound style sunglasses that sit close to the face; such glasses allow very little amount of unfiltered light to reach the eyes.

Several medical studies have however revealed that increasing the strength of the immune system can help in prevention of eye cancer. People suffering from HIV or having immunosuppressants for treatment of certain medical conditions often develop eye cancers. This proves the link between immune system functioning and occurrence of eye cancer.

Treatment of eye melanoma involves use of procedures like chemotherapy, radiation therapy and surgery. Here, we’ll be discussing about the different types of surgery used for treating eye melanoma.

1. Iridectomy: This surgical procedure is used for removing only the affected part of one’s iris. Patients suffering from small iris melanoma, which has not spread to any other part of the eye, are generally treated with iridectomy.
2. Iridotrabeculectomy: Iridotrabeculectomy is the surgical procedure used for removing affected portions of our iris and tissues located on the iris’s base for supporting our cornea. This procedure is also meant for treatment of small iris melanoma patients.
3. Iridocyclectomy: Iridocyclectomy is used for treating small melanoma affecting our ciliary body and iris.  The procedure is used for operating affected portions of the patient’s ciliary body and iris.
4. Choroidectomy: This surgical procedure is carried out for removing the affected parts of the patient’s choroid. The process may or may not include surgical removal of the walls of the patient’s eyes (this surgical method is called sclerouvectomy). Usually, a choroidectomy is followed by radiation therapy.
5. Enucleation: The process called enucleation involves surgical removal of an entire eye. A patient needs to undergo this procedure if he or she is suffering from a excessively large eye tumor. Doctors might also recommend this surgery to eye melanoma patients if they are experiencing severe eye pain due to the disease. The removal of the eye is followed by insertion of an implant in that place.

Stage 1 or small melanoma:

In this stage of eye cancer, small melanomas having approximate thickness of 1 to 2.5 mm and maximum width of 10mm appear. Small melanomas of the eye usually do not spread into any other tissue. The 5 year survival rate of patients in stage 1 of eye cancer is 84%. Melanoma of the eye generally does not show up any significant symptom when it is in stage 1. So, the disease mostly gets diagnosed in stage 1 through eye exams.

Stage 2 or medium melanoma:

In this stage the tumors grow in size and reach a diameter of 10 to 16 mm; the thickness of the tumor remains below 10mm. Even in stage 2, melanomas are unlikely to invade the other tissues and lymph nodes of the patient. The 5 year survival rate for patients in stage 2 of melanoma of the eye is 68%. In this stage, the patient may see light flashes, lines and spots (or floaters) in front of them. Partial vision loss is also a possibility.

Stage 3 or large melanoma:

In this stage the tumor becomes thicker than 10mm and its diameter increases to 16mm. In stage 3, the cancer might spread beyond the eyeball; however, still it does not invade lymph nodes. The 5 year survival rate of patients in stage 3 of eye cancer is 47%. The signs of melanoma of the eye in stage 3 are similar to those of stage 2.

Stage 4 or metastasizing melanoma:

This stage is the stage of metastasis i.e. in stage 4 of melanoma of the eye, the cancer spread to other organs and lymph nodes of the patient’s body. Prognosis of melanoma of eye in stage 4 varies depending on the extent of the spreading of cancer. The average 5 year survival rate of patients in this stage of eye cancer is 15%. The symptoms include decreased appetite, malaise and weight loss.

The condition is caused by occurrence of genetic mutations in the nerve cells of retina; the genetic mutation eventually results in uncontrolled growth and multiplication of the healthy cells. These cells are then accumulated to form tumors. The retinoblastoma cells might spread into other parts of our eye and its surrounding structures. There are also instances, when retinoblastoma has invaded distant body parts of the patient, for instance spinal cord and brain.

The exact causes of retinoblastoma is not found till date. However, most cases of retinoblastoma in children are believed to occur because of inheriting the genetic mutation from parents. The hereditary retinoblastoma gets passed to the children from parents following autosomal dominant patterns. This means for passing increased risk of developing retinoblastoma to the children, any one of the parents will require having one copy of mutated gene. If any one of the parents carries the mutated gene, every child will possess 50% more risk of inheriting the mutated gene. It’s true that genetic mutation results in increased risk of retinoblastoma in children; however, this does not mean that they will inevitably be affected by cancer. Hereditary retinoblastoma generally affects both eyes of a child.

Eye examination:

The eye specialist will examine your eyes for presence of any enlarged blood vessel, which can be an indicator of formation of tumors inside the eye. Doctors might use instruments for examining the eyes. One such method is known as ophthalmoscopy; in this process, the doctors use lenses carrying bright lights mounted on their forehead. The look of the device used for ophthalmoscopy is a lot like the miner’s lamp. The other method use by doctors for eye examination is biomicroscopy using a slit-lamp; in this method, the doctor used microscopes that produce intense beams for illuminating the inner part of the patient’s eyes.

Ultrasound of the eye:

In this method, sound waves of high frequency are passed through the eyes from a wand like device known as the transducer. This will create images of the patient’s eyes on the computer screen. Generally, the transducer gets placed on the surface in front of the eye or on the patient’s eyelid. Ultrasound test is mainly used for measuring the extent of the tumor’s growth and its thickness.

Blood vessel imaging or angiogram:

This diagnostic procedure involves injection of colored dye into the vein of the patient’s arm. This injected dye travels into blood vessels in and around the eyes. A camera will keep on taking images of the regions through which the dye passes; these images get displayed on the computer monitor.

Biopsy:

Biopsy is the procedure in which a sample tissue from the eye is surgically removed and tested for detecting the presence of cancer cells. In case of eye melanoma, this is the most commonly used diagnostic procedure.

When the doctor feels the need of checking whether metastasis of the eye cancer has taken place or not; he might ask the patient to undergo one or more of the following tests:

• CT scan
• X-ray
• Blood test for measuring liver function
• Abdominal ultrasound
• MRI

Determination of whether a person has choroidal melanoma is done by eye cancer experts through a comprehensive eye exam inclusive of enquiring about medical past, examination of both eyes, peering inside eyes at the tumor, conducting an ultrasound exam & dedicated photography for examining circulation inside the choroidal melanoma.

The expert would even order the person to undergo a total wide-ranging medical check-up & particular testing based on what is noticed within the eye. Intraocular choroidal melanoma could be diagnosed in above ninety-six percent of the cases without the need for biopsies. Although sporadically needed, biopsy is generally evaded since the eye is to be opened (that could let out cells of the choroidal melanoma) & danger of intraocular haemorrhages & infections.

Symptoms

Majority of the people with choroidal melanoma are asymptomatic & the disease is mostly spotted during regular eye exam. In case the patient is symptomatic, he/she would generally see light flares, distorted or lost vision & floater formations in eye sight.

• In case choroidal melanoma is present in the frontal portion of the eye, close to the lens then it could exert pressure or slant the innate lens leading to irregular astigmatism or blurriness in eyesight.
• The condition could drip fluid underneath the retina, causing its detachment & causal to symptoms like floater or light flashes.
• In case the macula or (core of vision) is the location of choroidal melanoma, it could spread under the fovea which makes the person develop far-sightedness. It could even show growth inside & obliterate the fovea leading to distorted, lost eye sight or alterations in the way colour is perceived.

It is crucial to bear in mind that majority of the patients having choroidal melanoma are totally asymptomatic and tumor presences discovered when they visited their ophthalmologist for regular eye exam. Hence, all must undergo eye exams periodically (inclusive of dilated ophthalmoscopies).

There could also be several atypical ways in which iridociliary/ ant. choroidal melanoma would present themselves like discoloured iris, glaucoma, a brownish mark on outer side of the eye or an uneven shape of the pupil.

Diagnosis & Tests

Choroidal melanoma could be spotted during ophthalmoscopies wherein the ophthalmologist would be looking via a lens inside the pupil post-dilatation.

The condition has characteristic analytic traits which comprise of, though not restricted to: pigmentations, less or medium inner ultrasound reflectivity, thicknesses, fluid seepage/detached retina (on/about the choroidal melanoma), orange pigment or lipofuscin on the exterior.

• Choroidal melanoma pigment is because of the innately present melanin which melanocytes in the choroidal layer produce. Pigmentation in choroidal melanoma is generally the case, though variable & also without pigment (amelanotic) arising because of increase in melanocyte cells which has lost their capability of making melanin.
• The presence of lipofuscin on choroidal melanoma is indicative of cell deaths on the tumor’s surface which is an indication of metabolic activity.
• Ultrasounds are classically deployed for measurement of choroidal melanoma dimension, evaluation of inner tumors reflectivity & checking for melanoma extensions at the rear of the eyes in to the orbits (extra-scleral extensions). Ultrasound reveals that majority of the choroidal melanoma cases have a dome-like shape & lesser prevalently of the shape of mushrooms. Ultrasounds could even assess choroidal melanoma linked to detached retina.
• Leakages could develop on or close to the choroidal melanoma – a discovery which suggests that the melanoma has improperly developed drippy blood vessels or that it’s corroding choroid from the superimposed retina. Leaking under the retina is causal to it getting detached – the extent to it ranging from a mini fluid cap on top of the tumor to a larger grave situation of detached retina.

Treatment

• Treatment for small choroidal melanomas is done following the patient’s foremost doctor’s appointment. However as development aids in proving that tumor are cancerous hence the physician might indicate wait and watch for a miniscule extent of choroidal melanoma development pre-therapy. The patient would be explained the pros and cons of wait and watch policy for growths versus instant therapy in case of choroidal melanoma. No sooner has documentation of the growths been done, specific therapy would be given by the eye cancer expert to the patient.
• Globally, the treatment for medium size choroidal melanoma is radiotherapy or removing the affected eye. Although there are numerous types of eyesight & eyes preservation radiotherapy, yet ophthalmic plaque radiotherapy is a rather commonly & broadly deployed procedure. As COMS finding indicate that plaque radiotherapy & enucleation of eyes have analogous efficacy in preventing metastatic choroidal melanoma, some patient types having moderate-size condition are given treatment which involves removing the eye. As these duo methods for treating choroidal melanoma could possibly be harming eyesight hence all the dangers & advantages, other therapy choices must be discussed when one consults an eye care expert.
• Patients having rather big-size choroidal melanoma might be offered treatment by eye excision or enucleation since extent of radiation necessary for obliterating choroidal melanoma filling majority of the eye might be more much than the eye is capable of tolerating. But, majority of the patients having big-sized choroidal melanomas could even be offered treatment using eye-preserving radiotherapy. Post-radiation for treating this condition, the eye is at an augmented risk of poorer vision, developing discomforting sensation & resultant removal necessary.

Though retinoblastoma might surface irrespective of age, it is generally observed among infants below 5 years. The tumor might affect one or both the eyes, though it is quite atypically noted to metastasize to the adjacent tissues or other areas of the body. Retinoblastoma is generally detected in just one eye and could generally be treated.

Retinoblastoma  – Due to gene mutation transferred to the off-spring

Retinoblastoma is at times inheritable. When it occurs due to inherent gene mutation, it is known as hereditary retinoblastoma. It has generally been observed to affect the younger age bracket than retinoblastoma that is non-inheritable. Retinoblastoma occurring in just one eye is generally non-inherent in nature. Retinoblastoma occurring in both eyes is always genetic. Hereditary retinoblastoma initially occurring in just one eye is likely to imminently affect the other eye. Following detection of retinoblastoma in one eye, follow-up examinations must be carried out at regular intervals of two to four months for no less than twenty-eight months. On conclusion of the retinoblastoma treatment, it is crucial that follow-up examinations be continued till the child reaches five years of age.

Treating both kinds of retinoblastomas must comprise of genetic advice being furnished by trained professionals regarding genetic diseases. Siblings of an infant that has retinoblastoma would also need to be regularly examined by an ophthalmologist and genetic counselling sessions be offered regarding the risks of getting cancer.

Infants having hereditary retinoblastoma more prone to trilateral retinoblastoma and other cancers

An infant with hereditary retinoblastoma is more prone to pineal tumors that might develop in the brain. This is known as trilateral retinoblastoma. Timely follow-up examinations employing Magentic Resonance Imaging (MRI) or computerised tomography (CT) scan for checking for this atypical condition is crucial while treating retinoblastoma and must be consistently followed till the child is five years of age. Children having hereditary retinoblastoma are also more prone to contracting other kinds of cancers during the later part of their lives.

Retinoblastoma Symptoms:

• The pupil of the eye appearing white rather than red when any light is focused on it. This might be perceivable in flash snaps of the infant.
• Eyes seem to looking in diverse directions.
• Pain and discomfort experienced in the eye and reddening.

Diagnosis & Tests:

The below-stated test and procedures could be conducted:

• Physical examination: During the physical exam, the body is checked for overall signs of health inclusive of any symptoms of diseases like lumps or any dubious occurrence. The person’s history in reference to family history, past medical conditions and health habits are also probed.
• Eye examination with pupil dilatation: Pupil dilatation or opening wider by using medicinal eye drops aids in easier viewing via the lens and pupil to the retinal area. An examination of the inner area of the eye inclusive of the retina and the optic nerve is carried out using an illuminated source. Dependent on what the age of the child is, the examination is performed after administering anesthesia.
• Ultrasound Examination: During this procedure echoes are produced by the high-energy ultrasound or sound waves that rebound off the surfaces of internal tissues or organs. These echoes form an image of the tissues it bounces off known as sonogram.
• CAT or CT scan: During this procedure, arrays of high-definition images of the internal organs like the eye are produced from varied angles by linking an x-ray machine to the computer. An intravenous dye injection might be given or ingested so that the images of the organs or tissues appear more lucidly on the CAT scan also referred to as the computed tomography, computerised tomography or computerised axial tomography.
• MRI (magnetic resonance imaging): Employing a magnet, radio waves and a computer, a series of in-depth images of the internal organs of the body like the eye are taken. Such a procedure is also known as NMRI or nuclear magnetic resonance imaging.

Retinoblastoma is generally detected without the need of carrying out a biopsy (tissue/cell removal for microscopic analysis to diagnose for the presence of cancer).

Prognosis (likelihood of recovery)

The prognosis or chances of recovery and the treatment choices hinge on certain below stated factors like:

• The staging of the cancer.
• The chances of saving eyesight in one or both the eyes.
• The extent and the amount of tumors.
• If trilateral retinoblastoma comes about.

Intraocular melanoma originates in the middle of the three layers of the wall of the eye. The outermost layer comprises of the white sclera or the white portion of the eye and the clear cornea in front of the eye. The innermost layer consists of nerve tissue lining known as the retina that detects light and transmits the images via the optic nerve to the brain.

The central layer known as the uvea or uveal tract is the place where intraocular melanoma is known to develop. The uvea comprises of three key parts namely:

Iris – The coloured part lying at the front of the eye and could be noticed via the clear cornea. The pupil is the core of the iris and it modifies size to allow greater or lesser light to enter into the eye.

Ciliary body – It is a band of tissue with muscle fibers located behind the iris that causes variations in the pupil size and the lens contour. The alterations in the shape of the lens help the eye in focussing. The ciliary body additionally produces the clear fluid that is known to fill the space in-between the cornea and the iris.

Choroid – The layer of blood vessels which supply oxygen and nutrients to the eye. Majority of the intraocular melanomas start in the choroid.

Risk Factors:

Any aspect that is known to increase the likelihood of developing a disease is known as a risk factor. Having a risk factor doesn’t necessarily imply that one would develop cancer. Conversely, the absence of risk factors also does not assure one not getting cancer. Those doubtful of being in risk of developing the disease must consult their doctor. The risk factors include:

• Those in the elderly age bracket.
• Being white.
• Those with light tone skin or with green/blue eyes.
• Those most likely to tan.

Eye Cancer Symptoms:

Though there are no preliminary symptoms

• A dark area noted on the iris.
• Experiencing fuzzy vision.
• An alteration in the shape of the pupil.
• Ocular changes.

In case the tumor causes a separation of the retina from the eye, then glaucoma could develop. If this occurs, then there might be not any symptoms or if present they might include:

• Pain experienced in the eyes.
• Blurring of vision.
• Reddish eyes.
• Feeling nauseous.