What is Eye Melanoma? Symptoms, Causes, & Treatment

Eye melanoma is a rare type of cancer that develops in the pigment-producing cells of your eye. While it sounds frightening, understanding this condition can help you recognize important signs and seek proper care when needed.

This cancer most commonly affects the uvea, which is the middle layer of your eye that includes the iris, ciliary body, and choroid. Think of these parts as the eye's support system that helps control light and nourishes the retina.

What is Eye Melanoma?

Eye melanoma occurs when melanocytes, the cells that give your eye its color, begin growing abnormally and uncontrollably. These are the same type of cells that can cause skin melanoma, but eye melanoma behaves quite differently.

The condition primarily affects adults, with most cases occurring in people over 50. Unlike skin melanoma, eye melanoma isn't caused by sun exposure, which often surprises people when they first learn about their diagnosis.

There are two main locations where eye melanoma can develop. Uveal melanoma affects the inner parts of your eye, while conjunctival melanoma develops on the clear membrane covering the white part of your eye.

What are the Symptoms of Eye Melanoma?

The challenging aspect of eye melanoma is that it often develops without causing noticeable symptoms in its early stages. Many people discover they have it during routine eye exams, which is why regular checkups matter so much.

When symptoms do appear, you might notice changes in your vision that develop gradually:

• Blurred or distorted vision in one eye
• Dark spots or shadows in your field of vision
• Flashing lights or floating spots that seem unusual
• A growing dark spot on your iris
• Changes in the shape of your pupil
• Loss of peripheral vision on one side

Some people experience a sensation that their eye feels different, though they can't quite pinpoint what's changed. Others notice that straight lines appear wavy or bent when looking with the affected eye.

In rare cases, you might develop pain or pressure in your eye, though this typically occurs only when the tumor has grown significantly. Remember, these symptoms can also indicate other, more common eye conditions, so experiencing them doesn't necessarily mean you have melanoma.

What are the Types of Eye Melanoma?

Eye melanomas are classified based on where they develop within your eye. The most common type is uveal melanoma, which accounts for about 85% of all eye melanomas.

Uveal melanoma can occur in three specific areas. Choroidal melanoma develops in the layer beneath your retina and represents the majority of cases. Ciliary body melanoma affects the muscle that controls your lens shape, while iris melanoma appears in the colored part of your eye.

Conjunctival melanoma is much rarer and develops on the thin, clear membrane covering the white part of your eye. This type is more similar to skin melanoma and may be related to sun exposure.

There's also an extremely rare form called orbital melanoma, which affects the tissues surrounding your eye socket. This type requires specialized treatment and often involves a team of different specialists.

What Causes Eye Melanoma?

The exact cause of eye melanoma remains largely unknown, which can feel unsettling when you're trying to understand why this happened. Unlike skin melanoma, eye melanoma isn't typically linked to sun exposure or UV radiation.

Researchers believe that genetic changes in melanocytes trigger the cancer, but what causes these changes isn't fully understood. Some studies suggest that certain genetic mutations might make some people more susceptible to developing this condition.

Environmental factors may play a role, though the evidence is limited. Some research has explored connections to welding, chemical exposure, or certain occupations, but no definitive links have been established.

Having light-colored eyes, particularly blue or green, appears to slightly increase your risk. Fair skin and difficulty tanning may also contribute to higher risk, though the connection isn't as strong as it is with skin melanoma.

When to See a Doctor for Eye Melanoma?

You should schedule an eye exam if you notice any persistent changes in your vision, especially if they affect only one eye. Don't wait to see if symptoms improve on their own, as early detection significantly improves treatment outcomes.

Contact your eye doctor promptly if you develop new dark spots in your vision, experience sudden vision changes, or notice a growing dark area on your iris. These changes warrant professional evaluation, even though they're more likely to be caused by other conditions.

If you have risk factors for eye melanoma, such as light-colored eyes or a family history of melanoma, discuss appropriate screening schedules with your eye care provider. Regular dilated eye exams can detect changes before symptoms develop.

Emergency care isn't typically necessary unless you experience sudden, severe vision loss or intense eye pain. However, don't hesitate to seek urgent care if you're concerned about rapid changes in your vision.

What are the Risk Factors for Eye Melanoma?

Understanding your risk factors can help you make informed decisions about screening and monitoring. Age is the most significant factor, with most cases occurring in people over 50.

Several physical characteristics may increase your risk:

• Light-colored eyes, especially blue or green
• Fair skin that burns easily
• Blonde or red hair
• Difficulty developing a tan
• Having many moles or freckles

Certain genetic conditions also elevate risk. Ocular melanocytosis, which causes increased pigmentation in your eye, and dysplastic nevus syndrome, involving abnormal moles, both require careful monitoring.

Having a family history of melanoma, either eye or skin, may slightly increase your risk. Some rare genetic syndromes, such as BAP1 tumor predisposition syndrome, significantly elevate the likelihood of developing eye melanoma.

Unlike skin melanoma, occupational sun exposure and tanning bed use don't appear to increase eye melanoma risk substantially. This distinction often surprises people and highlights how different this cancer is from its skin counterpart.

What are the Possible Complications of Eye Melanoma?

The most concerning complication is metastasis, where cancer cells spread to other parts of your body. Eye melanoma has a particular tendency to spread to the liver, which is why ongoing monitoring remains crucial even after successful treatment.

Vision-related complications depend on the tumor's size and location. Some people experience partial or complete vision loss in the affected eye, while others maintain functional vision throughout treatment.

Treatment itself can sometimes cause complications. Radiation therapy might lead to dry eye, cataracts, or retinal damage over time. Surgical removal of the eye, though sometimes necessary, requires adjustment to monocular vision.

Secondary glaucoma can develop when the tumor interferes with normal fluid drainage in your eye. This increased pressure can cause additional vision problems and may require separate treatment.

In rare cases, very large tumors can cause the eye to become painful or cosmetically concerning. Some people develop inflammation or bleeding within the eye, which can affect vision and comfort.

How is Eye Melanoma Diagnosed?

Diagnosis typically begins with a comprehensive eye examination where your doctor will dilate your pupils to examine the inside of your eye thoroughly. This allows them to see areas that might harbor melanoma.

Your eye doctor will use specialized instruments to examine your retina and other internal eye structures. They might take photographs or use ultrasound to measure any suspicious areas and determine their characteristics.

Fluorescein angiography involves injecting a special dye into your arm that travels to your eye's blood vessels. This test helps doctors see how blood flows around any suspicious areas and can reveal tumor characteristics.

Fine needle aspiration biopsy is sometimes used to obtain tissue samples, though it's not always necessary for diagnosis. Your doctor might recommend genetic testing of tumor cells to help predict behavior and guide treatment decisions.

Additional imaging studies, such as MRI or CT scans, help determine if cancer has spread beyond your eye. These tests are crucial for staging the cancer and planning appropriate treatment.

What is the Treatment for Eye Melanoma?

Treatment options depend on your tumor's size, location, and genetic characteristics, as well as your overall health and vision goals. The goal is always to eliminate cancer while preserving as much vision and eye function as possible.

Radiation therapy is often the preferred treatment for medium-sized tumors. Plaque brachytherapy involves temporarily placing a small radioactive disc against your eye, delivering focused radiation directly to the tumor over several days.

External beam radiation uses precisely targeted radiation from outside your body. Proton beam therapy, available at specialized centers, can deliver radiation with exceptional precision, potentially reducing damage to surrounding healthy tissue.

Surgical options include local resection, where surgeons remove the tumor while preserving your eye. Enucleation, or eye removal, becomes necessary when tumors are very large or when vision cannot be preserved.

For small tumors, your doctor might recommend careful monitoring with regular examinations. Some small melanomas grow very slowly and may not require immediate treatment.

Newer treatments include targeted therapy drugs that attack specific genetic mutations in melanoma cells. Immunotherapy, which helps your immune system fight cancer, shows promise for advanced cases.

How to Take Home Treatment During Eye Melanoma?

Managing side effects from treatment often requires specific care strategies you can implement at home. If you're receiving radiation therapy, you might experience eye irritation that responds well to prescribed lubricating drops.

Protecting your eyes from bright light becomes important during and after treatment. Wearing sunglasses and avoiding excessive screen time can help reduce discomfort and strain.

Maintaining good overall health supports your body's ability to heal and cope with treatment. Eating nutritious foods, staying hydrated, and getting adequate rest all contribute to your recovery.

Vision changes during treatment are common and usually temporary. Arranging your home environment to accommodate any vision limitations can help you maintain independence and safety.

Following your doctor's instructions about activity restrictions is crucial, especially if you've had surgery or are receiving radiation. Some treatments require temporary limitations on bending, heavy lifting, or strenuous activities.

How Should You Prepare for Your Doctor Appointment?

Before your appointment, write down all your symptoms, including when they started and how they've changed over time. This information helps your doctor understand your condition's progression and severity.

Compile a complete list of medications, supplements, and eye drops you're currently using. Some medications can affect your eyes or interact with treatments, so this information is essential for safe care.

Prepare questions about your diagnosis, treatment options, and what to expect during recovery. Don't hesitate to ask about success rates, potential side effects, and how treatment might affect your daily activities.

Bring a family member or friend to your appointment if possible. Having emotional support helps, and an extra person can help you remember important information discussed during the visit.

Gather any previous eye exam records or imaging studies you might have. These help your doctor track changes over time and can influence treatment decisions.

What's the Key Takeaway About Eye Melanoma?

Eye melanoma is a serious but treatable condition, especially when caught early through regular eye examinations. While the diagnosis can feel overwhelming, many people maintain good vision and quality of life with appropriate treatment.

The most important action you can take is scheduling regular comprehensive eye exams, particularly if you have risk factors or notice vision changes. Early detection significantly improves treatment outcomes and vision preservation.

Treatment has advanced considerably in recent years, offering more options for preserving vision while effectively treating cancer. Your medical team will work with you to develop a treatment plan that addresses both your cancer and your personal goals.

Remember that having risk factors doesn't mean you'll develop eye melanoma, and experiencing symptoms doesn't automatically indicate cancer. However, staying vigilant about your eye health and maintaining regular care provides the best protection.