🎟️ Eye Cancer — Ocular Melanoma & Retinoblastoma
The adult one and the childhood one. The white pupil that must never be dismissed.
🧬 The two that matter
Primary cancer inside the eye is uncommon, but two forms come up because each has a signature sign that a nurse can catch.
| Uveal (ocular) melanoma | Retinoblastoma | |
|---|---|---|
| Who | Adults, commonest primary eye cancer in adults | Children under 5 |
| Where | Uvea — choroid, ciliary body, iris | Retina |
| Signature sign | Often none early; found on routine eye exam | Leukocoria — a white pupil reflex |
| Risk | Light eyes, fair skin, older age, certain moles | Inherited RB1 gene in about 40% — often both eyes |
| Spreads to | Liver, characteristically | Locally, then brain and bone if untreated |
👀 What you can actually catch
Leukocoria is the one to know. Instead of the normal red reflex, the pupil reflects white — often first noticed by a parent in a flash photograph, where one eye glows red and the other white.
A white pupil in a young child is retinoblastoma until proven otherwise. Never reassure a parent that a white reflex in photographs is a camera artefact. It needs urgent ophthalmology referral.
Other signs in a child
- Strabismus — a turned or crossed eye, because the tumor has destroyed central vision
- A red, painful eye; a change in iris color
- Poor vision or an eye that does not fix and follow
This is why the red reflex is checked at every well-child visit, and why it matters that it is checked in both eyes and compared.
Adult ocular melanoma
- Frequently symptom-free until it is large — found on a dilated eye exam
- Blurred vision, flashes or floaters, a growing dark spot on the iris
- A shadow or loss in part of the visual field
- Diagnosed largely by examination and ultrasound — a biopsy risks seeding the tumor, so it is not the routine first step
🩺 Treatment & what the nursing is
- Radiation — plaque brachytherapy. A small radioactive disc stitched over the tumor for a few days. Follow the facility’s radiation-safety rules on time, distance and shielding, and on limiting visits by pregnant staff and young children.
- Laser therapy and cryotherapy for smaller tumors.
- Chemotherapy, systemic or delivered into the eye’s own artery, is central in retinoblastoma.
- Enucleation — removal of the eye — when the tumor is large or sight is already gone.
After enucleation. An implant and later a prosthesis restore appearance. Teach the family that a prosthesis is cleaned and handled with clean hands over a soft surface, and that the socket is inspected for drainage, swelling or odor. Expect grief about appearance and address it directly rather than brightly.
Protect the remaining eye. Safety glasses for sport and any hazardous activity become a lifelong rule — that eye is now the only one.
Genetics matters in retinoblastoma. A hereditary case means siblings and future children need screening, and the child carries a higher lifetime risk of other cancers. Genetic counseling is part of the care plan, not an optional extra.
Follow-up for melanoma is about the liver. Because uveal melanoma characteristically spreads there, surveillance includes liver imaging and liver function tests for years afterwards. A patient who asks why their eye cancer means a liver scan has just asked a very good question.