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Surgery for eye cancer
Surgery is one of the primary treatments used to treat eye cancer. Surgery is not used for ocular lymphoma. It is used for intraocular melanoma and orbital tumours and adnexal tumours to:
- potentially cure the cancer by completely removing the tumour
- reduce pain or ease symptoms (palliative treatment)
- treat a recurrence
The type of surgery done depends mainly on the size and location of the tumour and other factors, such as how the person’s vision is affected and a person’s age. Side effects of surgery depend on the type of surgical procedure.
Eye surgery is usually done by a specialist called an ophthalmologist. Before surgery, the surgeon will talk about what to expect from surgery, explain how surgery will affect your sight and appearance and answer any questions you have.
The following types of eye surgery are done while a person is under general anesthetic. The person usually stays in the hospital for a few days after surgery.
A surgical resection (excision) removes a tumour from the eye or removes part, but not all, of the eye. This type of surgery is an option for small melanomas of the eye. Some eye cancer surgeries that may be done are:
- removes part of the iris
- used for very small melanomas of the iris
- removes part of the iris and a small piece of the outer layer at the front of the eyeball (cornea)
- used for small melanomas of the iris
- removes part of the iris and ciliary body
- used for small melanomas of the iris
A tumour resection may be suitable for some small ciliary body or choroidal tumours.
Tumour resection can help preserve vision and maintain a normal looking eye.
An enucleation is removal of the entire eye. It is done to treat a large or advanced intraocular melanoma, but may also be done for some smaller eye melanomas if other types of treatment would destroy vision or if there isn’t any useful vision in the eye. Enucleation is also used for tumours that have spread throughout the eye or into the optic nerve. It is used if other more conservative treatments are not an option.
The eyelid, eye muscles, nerves and fat in the eye socket (orbit) are left in place. The person may need an orbital implant and artificial eye after enucleation. A padded bandage and a plastic shield are used over the eye area for a few days after surgery.
During the same operation that removes the eyeball (enucleation), an eye (orbital) implant is usually inserted into the eye socket. It is sewn with sutures into the tissues around the eye socket and the muscles that move the eye. The implant is round like an eye and made of silicone or a material similar to bone. It helps fill the space where the eyeball once was and supports an artificial eye. An orbital implant is permanent and can’t be removed.
A temporary plastic shell with a hole in the middle (called a conformer), which looks like a large contact lens, is often placed over the orbital implant. A conformer is used while the eye area heals before an artificial eye is fitted. Some people will not have a conformer.
In some cases, an orbital implant isn’t used. A conformer is used initially or an artificial eye is placed in the empty socket.
Generally, the conformer is removed a few weeks after surgery and the person is fitted with a temporary artificial eye (ocular prosthesis) by an ocular prosthetist or ocularist. An artificial eye is not round like an eyeball. It is a thin shell (similar to a big contact lens) that fits over the orbital implant and under the eyelid. The artificial eye moves in a similar way as the remaining eye, just not as much. The temporary artificial eye helps the person get used to wearing a prosthesis.
Most people get a permanent prosthesis 4–6 weeks after surgery. The permanent artificial eye is made to match the size and colour of the remaining eye.
Exenteration is surgery to remove the eyeball, eyelid, muscles, nerves and fat in the eye socket (orbit). This radical surgery is used for widespread tumours of the orbit or other eye tumours that have spread into the orbit. The orbital bone may be left intact if it doesn’t contain cancer.
The person can be fitted for an artificial eye or facial prosthesis after an exenteration.
Reconstructive surgery, which may include skin and bone grafting, may be done following extensive surgery to the orbit.