Patients needing treatment for eye tumors (benign or cancerous) will benefit from a highly trained and multispecialty team of experts at New York Eye and Ear Infirmary of Mount Sinai (NYEE) consisting of ophthalmologists from different subspecialties, ophthalmic pathologists, and imaging experts. In addition to diagnosing and treating the tumors, our oculoplastic surgeons help patients to regain their physical appearance after primary surgery. When needed, the Ocular Oncology Service will refer patients to the Mount Sinai network of specialists for any additional treatments or follow-up care.

Intraocular Melanoma

One of the most common cancers we treat, intraocular melanoma, begins in the pigmented cells of the middle layer of the eye wall, which contains blood vessels that bring oxygen and nutrients to the eye. It is the most common ocular cancer in adults. Signs may include a dark spot on the iris, blurred vision, floaters (spots in the field of vision), or flashes of light. Because intraocular melanoma can spread to other parts of the body, early detection and successful destruction of the tumor is critical to prevent metastasis.

Detection and treatment begin at New York Eye and Ear Infirmary with a complete ocular oncology examination. Intraocular melanomas are hidden within the eye, thus requiring advanced testing to pinpoint their size, complexity, and growth potential. Among the tools our clinicians and technicians use to evaluate these tumors are ultrasound imaging, transilluminiation, intraocular photography with angiography, and ocular coherence tomography. The Ocular Oncology Service has been estimated to be 99.6 percent accurate in diagnosing choroidal melanoma.

Treatment for Melanoma of the Eye

Thanks to advances in treating these tumors, the vast majority of patients no longer have to lose an eye (called enucleation surgery).  At the Ocular Oncology Service tumors are usually destroyed with eye plaque radiation therapy, which can preserve both the eye and its vision. In fact, should radiation retinal complications occur, Dr. Finger discovered that they can be treated with intraocular anti-VEGF therapy.

Doctors on the Ocular Oncology Service have had particular success with palladium-103 ophthalmic plaque radiation therapy. This is because compared to iodine-125 or ruthenium-106 plaque, palladium-103 offers a more favorable intraocular dose distribution and improved local tumor destruction.

In less than 5 percent of cases, the patient presents with a choroidal melanoma so large it cannot be cured by radiation and the eye is removed. However, despite this loss most patients on the Ocular Oncology Service are happy with the way they look after being fit with an artificial, cosmetic eye.

Tumors of the Eyelid

The majority of eyelid tumors are benign, though some are malignant and can spread to other parts of the eye if not treated. The following are the major types of eyelid cancer:

Basal Cell Carcinomas

These are the most common malignant eyelid tumors, noticeable on the inner portion of the lower eyelid as a raised, pearly nodule. Prolonged exposure to sunlight is a risk factor for basal cell carcinoma. Treatment typically involves complete removal of the tumor. The resulting eyelid defect can be repaired by an oculoplastic surgeon at New York Eye and Ear, restoring the physical appearance of the area impacted by surgery.

Squamous Cell Carcinomas

The second most common type of malignant eyelid tumor, squamous cell carcinomas result from the growth of squamous cells that make up much of the epidermis, the skin’s outermost layer. Like basal cell carcinomas, they often appear as elevated growths on the lower eyelid, and typically result from overexposure to ultraviolet radiation from the sun. Surgery to completely remove the carcinoma is the most effective treatment. However, doctors on the Ophthalmic Oncology Service are starting to use topical chemotherapy ointment and freezing (cryotherapy) to destroy these tumors without excisional surgery.

Sebaceous Cell Carcinomas

These highly malignant tumors originate in the glands of the eyelid and if not aggressively managed by an ophthalmologist can spread to the eye socket (orbit), lymph nodes, and body. Sebaceous cell carcinomas may appear as a stye, sometimes leading to clinical misdiagnoses. Any stye that lasts more than three months should be evaluated to determine if it is a sebaceous cell carcinoma. Prompt surgical removal is usually required, often with additional radiation or cryotherapy (freeze therapy). A systemic survey will be performed for moderate and large-sized tumors.

Tumors of the Iris

Though uncommon, tumors can grow within the iris, the colored part of the eye. Since tumors of the iris are less likely to spread to other parts of the body, most can be monitored with high frequency ultrasound for evidence of growth before biopsy or treatment. They can also be biopsied through a safe, minimally invasive procedure called the Finger Iridectomy Technique (FIT), invented at NYEE. FIT involves making a tiny, self-sealing incision, then using an aspiration cutter to gently obtain iris tumor tissue for pathology examination.

Most iris malignancies are melanoma. In the past, these tumors were surgically removed causing a permanently enlarged and fixed pupil. Because the pupil was chronically dilated, patients suffered from glare and light sensitivity. In 1989, Dr. Finger first started using radiation plaques on the cornea to destroy the tumor without harming the normal iris. Now patients can keep their pupil and rarely suffer from glare or light sensitivity.

Conjunctival Tumors

These malignant growths visible on the surface of the eye can spread to interior structures if not properly treated. Diagnosis is made by ophthalmic oncology examination aided by biopsy. That said, conjunctival melanomas typically require surgical biopsy with cryotherapy, and squamous carcinomas can be diagnosed with a simple office procedure developed by Dr. Ekaterina Semenova at New York Eye and Ear Infirmary of Mount Sinai.

Dr. Finger pioneered the use of topical chemotherapy eye drops (mitomycin and interferon) for patients with conjunctival melanoma. Though we still need to take a biopsy to confirm the diagnosis, topical chemotherapy not only successfully treats the local cancer, but decreases the chance of scarring.

In contrast, most conjunctival squamous carcinomas can be treated with chemotherapy eye drops (interferon, 5-fluorouracil, or mitomycin) alone. Recent research conducted by doctors on the Ophthalmic Oncology Service has found that even large squamous tumors can be cured with eye drops.

Orbital Tumors

These tumors invade the eye’s orbit (the bony cavity around the eye, which contains the eye muscles, the optic nerve, and related blood vessels). Orbital tumors include but are not limited to lymphomas, hemangiomas, lymphangiomas, meningiomas, optic nerve gliomas, sarcomas, and schwannomas. They can be either benign or malignant, and can originate from the orbit (primary tumor) or from elsewhere in the body (secondary tumor). Signs of an orbital tumor are a bulging eyeball, vision loss, or double vision. These tumors are diagnosed by clinical examination of the eye and orbit, supplemented by an MRI or CT scan, followed by a biopsy, known as an orbitotomy.

Dr. Finger has developed a safe and minimally invasive biopsy procedure that involves a tiny, self-sealing incision. Then an aspiration cutter-tube is inserted into the tumor (instead of a sharp needle biopsy). However, in some cases a standard, open incisional biopsy is needed. Then with the clinical diagnosis supported by biopsy, a treatment plan is developed. Depending on the type of tumor, treatments may be as simple as observation or complete tumor excision; or as complex as surgery to completely remove the tumor followed by radiation or chemotherapy. When treatments get complex, doctors at the Ocular Oncology Service will coordinate patient care with Mount Sinai’s radiation oncology and medical oncology services.

Retinoblastomas

Though rare, retinoblastomas are the most common type of malignant eye tumor seen in children, particularly those under five. Retinoblastomas occur on the retina, the light-sensing part of the eye, and can affect one or both eyes. At New York Eye and Ear infirmary, we work closely with our oncology, pediatric oncology, interventional radiology, and hematology colleagues at Mount Sinai Health System to ensure retinoblastoma patients receive the most comprehensive and appropriate treatment.

If a retinoblastoma is detected early, these tumors can be successfully treated through laser or intra-arterial chemotherapy. More advanced cases may require systemic chemotherapy or removal of the eye (enucleation). The specialists at the Ophthalmic Oncology Service and the Mount Sinai Health System make every effort to preserve a child’s eye, their vision, and their life.