Eye: Ocular Tumors

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OCULAR TUMORS
These tumors can be either benign or malignant.
This  tumor can affect the eye socket, eyeball, eye muscles, optic nerve, fat, and tissues.

Types
Choroidal Hemangioma
A hemangioma is a tumor comprised of blood vessels and can grow within the choroid, the blood vessel layer beneath the retina.
Choroidal hemangiomas are not malignant and never metastasize.
However, if the hemangioma is located in the area of central vision of the eye it can leak fluid that causes a retinal detachment and visual function may be affected.
Treatment options may include photodynamic therapy, laser photocoagulation to decrease the amount of fluid leakage, or low doses of external beam radiation therapy.

Choroidal Melanoma
  • Choroidal melanoma is the most common primary intraocular tumor in adults.
  • It arises from the pigmented cells of the choroid of the eye and is not a tumor that started somewhere else and spread to the eye.
  • A choroidal melanoma is malignant, and eventually spread to other parts of the body.
  • Because choroidal melanoma is intraocular and not usually visible, patients with this disease often do not recognize its presence until the tumor grows to a size that impairs vision by obstruction, retinal detachment, hemorrhage, or other complication.
  • Pain is unusual, except with large tumors. Periodic retinal examination through a dilated pupil is the best means of early detection.
  • Treatment is with radioactive therapy or enucleation

Choroidal Nevus
  • Like a raised freckle on the skin, a nevus can occur inside the eye.
  • And, like a skin nevus, a choroidal freckle can become malignant, so should be closely monitored.
  • A choroidal nevus should be examined by an ophthalmologist every four to six months to check if the pigmentation or size of the nevus has changed.
  • A choroidal nevus should be examined by an ophthalmologist every four to six months to check if the pigmentation or size of the nevus has changed.
  • Treatment - close observation and monitoring by an ocular oncologist.

Conjunctival Tumors
  • Conjunctival tumors are malignant cancers that grow on the outer surface of the eye.
  • The most common types of conjunctival tumors are squamous cell carcinoma, malignant melanoma, and lymphoma.
  • Squamous cell carcinomas rarely metastasize, but can invade the area around the eye into the orbit and sinuses.
  • Malignant melanomas can start as a nevus (freckle) or can arise as newly formed pigmentation.
  • Lymphoma of the eye can be a sign of systemic lymphoma or be confined to the conjunctiva.

Eyelid Tumors   
  • Tumors of the eyelid may be benign cysts, inflammation, or malignant skin cancers.
  • The most common type of eyelid cancer is basal cell carcinoma.
  • Most basal cell carcinomas can be removed with surgery. If left untreated, these tumors can grow around the eye and into the orbit, sinuses and brain.   A simple biopsy can determine if an eyelid tumor is malignant.
  • Malignant tumors are completely removed and the eyelid is repaired using plastic surgery techniques. Additional cryotherapy and radiation therapy sometimes are required after surgery,

Iris Tumors
  • Tumors can grow within and behind the iris.
  • Though many iris tumors are cysts or a nevus, malignant melanomas can occur in this area. Most pigmented iris tumors do not grow. They are monitored with a special slit lamp and high frequency ultrasound to establish a baseline for future comparisons.
  • When an iris tumor is documented to grow, treatment is recommended.   Most small iris melanomas can be surgically removed. Radiation plaque therapy or enucleation may be considered for larger iris tumors.

Lymphoma
  • Lymphoma tumors can appear in the eyelid tissue, tear ducts and the eye itself.
  • In most patients with large cell non-Hodgkin's lymphoma, the disease is confined to the eye and central nervous system. In these patients, symptoms appear in the eye an average of two years before they are seen elsewhere.
  • The disease itself as well as treatment, which may include external beam radiation,  chemotherapy, or both (chemo radiation) to the central nervous system, can affect visual functioning.

Melanocytoma
This extremely slow-growing tumor usually is found on the surface of the optic disc.
Almost all cases of melanocytoma are benign and malignant transformation is rare.
It is probably present at birth and typically, there are no symptoms.
Under clinical examination and fluorescein angiographic studies, melanocytoma  appears as a deeply pigmented area located over the optic disc.
In the majority of cases, close observation is recommended and no treatment is required. If malignant transformation does occur, enucleation, may be considered.

Orbital Tumors
  • Tumors and inflammations can occur behind the eye.
  • These tumors often push the eye forward causing a bulging of the eye called proptosis.
  • Other tumors include hemangiomas (blood vessel tumors), lachrymal (tear) gland tumors, and growths that extend from the sinuses into the orbit.
  • Though CT scans, MRI's and ultrasounds help in determining the probable diagnosis, most orbital tumors are diagnosed by a biopsy.

Other orbital tumors are
Optic nerve glioma, a benign tumor often associated with neurofibromatosis
Orbital meningioma, a tumor growing from the tissue covering the brain
  • Hernangioma, a benign tumor made up of blood vessels or vessel elements.
  • Lymphangioma, a tumor made up of enlarged lymphatic vessels
  • Neurofibroma, a tumor made up nerve cells
  • Sarcoma, a malignant tumor growing from connective tissue

RETINOBLASTOMA
A malignant retinal tumor occurring in 1 of every 15,000 live births, it is hereditary in 30% to 40% of cases. All bilateral cases are hereditary.
Signs and symptoms- an initial leukocoria or "white" pupil with a peculiar light reflection and possibly strabismus as well. Less frequent signs are uveitis, glaucoma, hyphema, nystagmus, and periorbital cellulitis.

Treatment - enucleation, if the tumour is large and unilateral. If the eye is removed before cancer spreads to the optic nerve, the cure rate is greater than 90%.

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notes.nursium.com: Eye: Ocular Tumors
Eye: Ocular Tumors
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