Intraocular tumours

Intraocular tumours

Uveal tract tumours – iris, ciliary body, and choiroidal melanomas

Retinal tumours – Retinoblastoma

Metastatic tumours

Uveal tract tumours

IRIS• Naevi – Benign – flat to slightly elevated

lesions .

• Melanoma – 5-10% of uveal melanomas – age 50-60 years, elevated and more pigmented

Treatment: local resection +/- radiotherapy – good prognosis

Uveal tract tumours

Iris naevus Iris melanoma

Ciliary body melanomas • 10% of uveal melanomas – only visualised when pupil is

widely dilated. • Presentation depends on size and location – lens

subluxation or localised lens opacities, sentinal vessels, erosion into anterior chamber, posterior extension retinal detachment.

• Ultrasound may be necessary • Treatment – enucleation, local resection, radiotherapy • Prognosis is poor as presentation is usually late

Ciliary body melanomaPicture on left showing black mass in red reflex

Picture on right showing tumour pushing on and displacing the lens

Choroidal melanoma/ Malignant melanoma

• 85% of uveal melanomas, most common during sixth decade of life

• Raised pigmented oval shaped mass(occasionally amelanotic)

• Commonly asymptomatic – found on routine fundal examination – may cause decreased visual acuity or defect in visual field – can cause an exudative retinal detachment, secondary glaucoma, cataract or uveitis

Choroidal melanoma MM

Peripheral MM MM at macula

Diagnosis of choroidal melanoma

• Ocular ultrasound – gives a measurement of size of tumour particularly the height, also differentiates between a normal retinal detachment (RD) and RD caused by tumour

• MRI of orbits and optic nerves to check for extra scleral spread

• Fluorescein angiography, shows increased vascularity and leakage from tumour

Differential diagnosis of choroidal melanoma

• Retinal detachment• Metastatic tumour• Neovascular ARMD• Large choroidal naevus

Medical evaluation of patient with choroidal melanoma

• Exclude a metastatic tumour – lung tumours in males and breast tumours in females are the commonest tumours that spread to the eye

• Detection of distant metastases – choroidal melanomas spread to the liver and lung

• Chest x ray, abdominal ultrasound, MRI, mamography

Management of choroidal melanoma

• Consider visual acuity of involved eye• Size, location, extent and apparent

activity of involved eye• State of fellow eye• General health and age of patient

Treatment of choroidal melanoma • Radioactive plaques • Enucleation• Cyclotron – generated charged particle

radiation• Photocoagulation• Trans pupillary thermotherapy• Localised resection• Exenteration• Palliation with chemotherapy

Retinoblastoma

• Tumours of primitive photoreceptor cells of eye.

• Most common primary malignant intraocular tumour in childhood – one in 20,000 live births

Retinoblastoma

• Average age at diagnosis 18 months – majority diagnosed by three years of age

• Early treatment can save vision, and the life of the patient

• Other primary tumours such as sarcomas may develop in about 10% of patients

Retinoblastoma

Children present most commonly with Leucocoria

and/or

Squint

Retinoblastoma

Fundal picturePinkish white raised lesions with blood vessels on

surface (may show calcification on Xray)or Retinal detachment

Left convergent squint and leucoria

Retinoblastoma

• 1/3 are bilateral –these present earlier than unilateral tumours. Most bilateral tumours are familial, autosomal dominant. Only 6% of patients have a positive family history. Patients with familial retinoblastoma have a 50% risk of transmitting the disease to their children.

• Sporadic cases usually uni-ocular but can be bilateral.

Retinoblastoma

These tumours spread trans sclerally to orbits, via the optic nerves to the brain and via blood to bone marrow

Investigations – ultrasound, CT, MRI,

Retinoblastoma

Treatment –• enucleation,• radiotherapy (external beam,

plaque),• thermotherapy,• cryotherapy,• chemotherapy

Retinoblastoma

Very important

Any child under 5 years of age who has leucocoria, a squint or loss of vision must be examined to out rule Retinoblastoma

Metastatic Tumours

More common than primary malignancies Common primary site in women – breast

In men – bronchus Less common sites kidney, testis, GIT.May present with decreased visual acuity in one or

both eyes• Solitary or multiple creamy white placoid or oval

lesions.• Treatment: Chemotherapy and/or radiotherapy

Metastatic tumour from breast cancer