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Most eye cancers are melanomas (also known as ocular melanomas or intraocular melanomas). Some eye melanomas are treated with surgery, but most are treated with radiation therapy instead.

If eye surgery is recommended

If your doctor recommends surgery, the type of surgery will depend on:

• The location and size of the tumor
• How far it has spread
• Your overall health and preferences

Eye surgery is typically done by an ophthalmologist, a medical doctor who specializes in treating eye diseases. This type of surgery is challenging to do and can have major side effects, so it is best done in a center that has a lot of experience with eye surgery.

Operations for eye cancer are done while you are under general anesthesia (in a deep sleep so you won’t feel pain). Most people will stay in the hospital 1 or 2 days afterward.  

Surgery for small iris melanomas

For some melanomas in the iris (the colored part of the eye), there may be several options, depending on where the cancer is and what tissues might be affected.

• Iridectomy: Removal of part of the iris.
• Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball.
• Iridocyclectomy: Removal of a portion of the iris and the ciliary body.

Surgery for melanoma of the ciliary body or choroid

For melanoma of the ciliary body or choroid, a transscleral resection might be an option.

This surgery should only be done by doctors in cancer centers with a lot of experience in treating eye melanomas because it is hard to remove the tumor without damaging the rest of the eye. This could lead to severe vision problems.

Surgery to remove the eye

Sometimes a more extensive surgery that removes the eye might be needed to treat eye cancer. The type of surgery will depend on whether the cancer has spread.

• Enucleation: Removal of the entire eyeball. This can be used for larger melanomas, but it may also be done for some smaller melanomas if vision in the eye has already been lost or if other treatment options would destroy useful vision in the eye anyway.
• Orbital exenteration: Removal of the eyeball and some surrounding structures such as parts of the eyelid and muscles, nerves, and other tissues inside the eye socket. This surgery is not common, but it might be used for melanomas that have grown outside the eyeball into nearby structures.

During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eyeball, so it should move the same way as the original eye would have.

Within a few weeks after surgery, you will see an ocularist (a specialist in eye prostheses) to be fitted with an artificial eye, a thin shell that fits over the orbital implant and under the eyelids. The artificial eye will match the size and color of the remaining eye. Once it’s in place, it will be hard to tell it apart from the real eye.

Possible risks and side effects of eye cancer surgery

All surgery carries some risk, including the possibility of pain, bleeding, blood clots, infections, and complications from anesthesia.

Vision loss

Surgery on the eye can lead to the loss of some or all of the vision in that eye.

• Removing an eye will mean losing vision completely and immediately on that side.
• Other surgeries can also cause problems that could lead to a loss of vision.

Sometimes, vision may have already been damaged or lost because of the cancer.

Cancer recurrence

If the eye is spared and only the tumor is removed, the risk of the cancer coming back is higher. Because of this, radiation is often given after surgery to help lower this risk.

Appearance

Removing an eye will affect a person’s appearance, but usually an artificial eye can be put in place to help. After an orbital exenteration, reconstructive surgery in the area around the eye socket might be an option as well.