Surgery for eye cancer

Most people with eye cancer will have surgery. The type of surgery you have depends mainly on the size and location of the tumour, your age and the stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your overall heath, personal preference and whether or not the tumour is affecting your vision.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible (called debulking) before other treatments
• reduce pain or ease symptoms (called palliative surgery)
• place a radioactive implant used in brachytherapy (a type of radiation therapy)

Eye surgery is usually done by a specialist called an ophthalmologist. Before surgery, the surgeon will talk about what to expect from surgery and explain how surgery will affect your vision and the way you look (your appearance).

The following types of surgery are used to treat eye cancer. You may also have other treatments before or after surgery.

A resection removes the tumour and a small amount of healthy tissue around the tumour. This type of surgery helps to save the vision in the affected eye and usually doesn’t change the appearance of the eye or face. It is sometimes used to remove small tumours in the eye or around the eye. During a resection the doctor makes a surgical cut (an incision) in the eyeball to remove the tumour. Some types of resections are named after the part of the eye that is opened or removed.

• Iridectomy removes part of the iris.
• Iridotrabeculectomy removes part of the iris and part of the cornea.
• Iridocyclectomy removes part of the iris and the ciliary body.
• Choroidectomy removes part of the choroid.
• Transscleral resection removes a tumour in the ciliary body or choroid. An incision is made in the sclera.
• Block excision is sometimes used to treat a small intraocular melanoma in the choroid. It removes the tumour and part of the wall of the eye (choroid, retina and sclera) around the tumour. This surgery is sometimes called a sclerouvectomy.

An enucleation removes the entire eyeball and part of the optic nerve. The eyelid, eye muscles and other nerves and fat in the eye socket (orbit) are left in place.

Enucleation is sometimes used:

• to treat very large tumours in the eye
• to treat smaller eye tumours if other types of treatment would also destroy vision or if there isn’t any useful vision in the eye
• if the cancer has spread to the optic nerve
• if the cancer has come back (recurred) after other treatment
• if a person prefers to have their eye removed instead of having another treatment

Enucleation isn’t used as often today as it was in the past. Most people can be treated with radiation therapy or other treatments that help to spare the eye and preserve vision.

If you have an enucleation, you will get an orbital implant and artificial eye.

An artificial eye (ocular prosthesis) is used to replace an eye that has been removed with surgery. But you won’t be fitted for an artificial eye until the area has had a chance to heal. During the enucleation surgery, the doctor will place a plastic disc (called a conformer) in the eye socket to keep its shape.

About 3–6 months after surgery, you will be fitted for an artificial eye. A mould will be made of the eye socket. The artificial eye will be made to fit the socket and painted to match the colour of the other eye. Until the permanent prosthesis is made, a temporary artificial eye may be used. An artificial eye may be held in place with an orbital implant (a device surgically attached to the eye socket that helps keep the artificial eye in place).

An orbital exenteration is surgery to remove the eyeball, eyelid, muscles, nerves and fat in the eye socket. If cancer has spread to the bones of the eye socket, some bone may also be removed. This surgery is used for tumours that start in the eye socket or those that have spread outside of the eye to the eye socket.

An orbital exenteration is major surgery that will change how you look. It is only used if the cancer has spread to most of the eye socket and a person is in a lot of pain or discomfort.

A person will be fitted for an artificial eye after an orbital exenteration. Some people may also get a facial prosthesis if surgery damaged the shape of the face.

Mohs surgery removes a tumour in layers. Each layer is looked at in the lab until no cancer cells are seen. Mohs surgery is sometimes used to treat a tumour in the eyelid or conjunctiva. Learn more about Mohs surgery.

Cryosurgery uses extreme cold to freeze and destroy tissue. During cryosurgery, the doctor applies liquid nitrogen to the lesion. This freezes the area and then scar tissue forms. The freezing may be repeated during the same appointment.

Cryosurgery may be used:

• as the main treatment for eyelid cancer or a tumour in the conjunctiva
• after a resection for intraocular melanoma
• after an enucleation if cancer has spread outside of the eyeball

Learn more about cryosurgery.

Laser surgery uses a laser (a powerful beam of light) to make bloodless cuts in tissue. The laser beam heats and vaporizes abnormal cells. Laser surgery is also called photocoagulation.

Laser surgery may be used:

• as the main treatment for a small and thin intraocular melanoma
• after a resection for intraocular melanoma
• after brachytherapy for intraocular melanoma

Learn more about laser surgery.

Transpupillary thermotherapy (TTT) is a type of laser surgery. It uses an infrared light to heat and destroy cancer cells. It is sometimes used after brachytherapy to treat intraocular melanoma.

Surgery may be an option for some people whose cancer has spread to the liver. Surgery to remove cancer in the liver is called a liver resection or a hepatic resection.

Surgery for eye cancer may damage the tissue surrounding the eye, which can affect the way you look. Reconstructive surgery may be needed to repair damage after surgery, to improve eye function or to improve appearance. Most reconstructive surgery for eye cancer is done at the same time as the surgery to remove the cancer. But in some cases, more than one surgery may be needed.

A skin graft is a piece of healthy skin taken from one part of the body (the donor site) and placed over the area where skin cover is needed. It may be used to reconstruct an eyelid.

A bone graft may be used to reconstruct the nose, cheekbone or other bones in the face that are removed during surgery. Common donor sites for bone grafts are the shoulder blade, the hip bone or a bone from the lower leg (the fibula). The bone is reshaped and used to replace bone in the face.

A sclera graft may be used to repair the wall of the eye after a resection. The piece of sclera comes from another person who has donated this tissue.

A conjunctival graft may be used to repair the area where a tumour in the conjunctiva has been removed. The graft is taken from the same eye or your other eye.

Surgery may be used to place the radioactive plaque used in brachytherapy, a type of radiation therapy. The radioactive plaque is placed over the eye tumour and sewn into the sclera to keep it in place. The plaque gives off radiation therapy to treat the tumour and is left in place for about 4–7 days.

Side effects can happen with any type of treatment for eye cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for eye cancer may cause these side effects:

• pain
• bleeding or a blood clot
• infection
• headache
• cataracts – a condition of the lens of the eye that causes poor vision
• vision problems or loss of vision
• shifting of the orbital implant – this can be repaired with surgery to put the implant back in place
• detached retina

A detached retina is a separation between the 2 layers of the retina. A detached retina causes a blurry or blind spot in the field of vision and you may also see spots or flashes of light. These symptoms should be reported to an eye care specialist right away since a detached retina can lead to blindness. Surgery is needed to fix a detached retina.

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.