Ocular oncology involves the diagnosis and treatment of benign and cancerous tumors in or around the eye. Tumors may develop on the surface of the eye, eyelids and tissue within the eye. Tumors may originate in eye tissue or spread from another cancerous tumor in a different part of your body.

Tumors in and around the eye can be cancerous (malignant) or noncancerous (benign). Malignant tumors can originate in the eye, such as ocular melanoma (also known as uveal melanoma) and lymphoma, or can spread to the eye from other parts of the body (metastasis, lymphoma).

Benign tumors inside of the eye, including hemangioma, can occur on their own (idiopathic) or occur as part of a syndrome that affects other parts of the body. Benign tumors like hemangioma can be treated at The Ohio State University Wexner Medical Center with photodynamic therapy, laser, intraocular injections and other surgical approaches. Other benign tumors, like choroidal nevus, are monitored for the development of malignant growth using a plan based on each individual patient’s tumor.

The Ohio State Wexner Medical Center’s ocular oncology team uses the latest diagnostic methods and treatment approaches to catch ocular tumors early, prevent spread and improve outcomes. The Ohio State Wexner Medical Center’s ocular oncology team has three goals: save lives, save eyes and save vision.

Ocular oncology conditions treated

The Ohio State University Wexner Medical Center and The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) have the expertise to diagnose and treat all tumors of the eye from the rare to the more common. Conditions treated by The Ohio State Wexner Medical Center’s ocular oncology team include:

Ocular surface tumor 

• Conjunctival malignancies: including conjunctival melanoma and non-melanoma, such as squamous cell carcinoma 
• Ocular surface squamous neoplasia: can develop into squamous cell carcinoma 
• Primary acquired melanosis: can develop into melanoma 

Intraocular tumor 

• Retinal tumor 
• Uveal melanoma 
• Intraocular metastasis 
• Lymphoma – primary vitreoretinal or secondary 
• Choroidal hemangioma  
• Retinal hemangioblastoma 
• Choroidal nevus 
• Melanocytoma 
• Congenital hypertrophy of the retinal pigment epithelium (CHRPE) 

Orbital malignancies

• Any cancer that originated elsewhere and spread to eye (the orbit or adnexa) 
• Lymphoma

Ocular melanoma symptoms

Symptoms of tumors in or around the eye vary based on the cause of tumor and location. Ocular melanoma may not cause early symptoms and is often discovered during a routine eye exam.

Other symptoms of tumors in or around the eye can include:

• Changes in vision 
• Floaters (spots that drift in your field of vision) or flashes of light 
• A shadow or new blind spot in the vision 
• Movement, like a fan moving in the line of vision 
• A change in the size or shape of the pupil or a dark spot on the eye 
• A change in the position of the eyeball in the eye socket 
• Eye pain or headache

Ocular tumor diagnosis

The following methods are used to screen for and diagnose tumors in and around eye:

• Cancer screening exams: Screening exams can detect cancer early, providing more time for treatment and improving outcomes. The American Academy of Ophthalmology recommends a dilated eye examination by age 40 to check for ocular melanoma and other ocular conditions.  
• Radiology imaging exams: Head imaging exams, including a CT scan and MRI scan, can detect intraocular and orbital tumors. 
• Ophthalmic imaging exams: Optical coherence tomography (OCT) takes high-resolution images of the eye to produce a 3D image of what’s happening beneath the surface of the eye. Fundus photography uses a special camera to take an image of the eye that allows the doctor to see the main structures of the inside of the eye and the back of the eye. Ocular ultrasound is used to assess the acoustic properties of intraocular tumors as well as their size, shape and associated subretinal fluid. 
• Genetic testing: Doctors and researchers at the Ohio State Wexner Medical Center are leading the way in identifying genes, like BAP1, that may be correlated with eye tumors. If a patient has a gene that’s linked with a higher risk of developing eye tumors, they can be placed on a preventive screening program to regularly check for tumor development and start treatment early if it does develop.

Treatment of ocular tumor

The Ohio State Wexner Medical Center’s team of experts collaborate to provide the most personalized medical or surgical treatment for your type of cancer or eye tumor. Treatment options may include:

Medication 

• Immunotherapy: Your doctor may work with a medical oncologist who will prescribe drugs that interfere with the growth and spread of cancer cells by helping your immune system attack the cancer cells more aggressively.  
• Chemotherapy: Your doctor may prescribe chemotherapy, such as rituximab, methotrexate and mitomycin C, medications that target certain cancer cells. Chemotherapy may be administered through eye drops, injections in or around the eye or sometimes systemically.  

Radiation

• External beam radiation: Your doctor will use radiation to target and destroy tumor cells in the eye and orbit.  
• Brachytherapy: Your doctor will insert and remove a radioactive plaque on the eye over the tumor, to destroy the cancer cells with radiation.  

Laser

• Your doctor may be able to use laser treatment to destroy some tumors. Sometimes the laser is combined with a medication, delivered intravenously, that can be activated by the laser once inside the tumor (photodynamic therapy)

Surgery 

• Resection: Your doctor may be able to remove the tumor by cutting it away from healthy tissue.  
• Cryotherapy: Your doctor may use a small probe that gets very cold to freeze and destroy invisible tumor cells.

Additional treatments include medications injected in the eye (e.g., anti-vascular endothelial growth factor [VEGF] injections) and retinal laser treatments. Learn more about ocular melanoma treatments at the OSUCCC – James.

Why choose Ohio State for ocular oncology

The Ohio State Wexner Medical Center offers an integrated program between Ophthalmology and Oncology backed by a strong multidisciplinary team. This collaboration allows for dedicated research, improved screening, close monitoring of ocular tumors and access to cutting-edge clinical trials.

The multidisciplinary care models fostered at the Ohio State Wexner Medical Center allow for teams of experts to collaborate on treatment of rare, multi-system diseases, such Von Hippel-Lindau disease (VHL). OSUCCC – James is one of just a few cancer centers in the country offering a VHL consortium, creating opportunities for physicians to share in research and treatment plans and develop better care for patients.

The Ohio State Wexner Medical Center offers world-leading care and expertise on the BAP1 tumor predisposition syndrome. Special interdisciplinary clinical services are available for affected patients and their families for early discovery, prevention and personalized treatment.

The Ohio State Wexner Medical Center’s ocular oncology department is committed to implementing research discoveries into precision medicine and providing you the most individualized care available.