Intraocular tumours

Children

Retinoblastoma is a multicentric malignant tumour of the retina, which can be bilateral. Some are sporadic, but many are hereditary. Children with a family history should be carefully monitored from birth. It is often not spotted until the tumour fills the globe and presents as a white reflex in the pupil (Fig. 36.12). Differential diagnosis is from retinopathy of prematurity, primary hyperplasic vitreous and intraocular infections. If the tumour is large, enucleation may be required, but radiotherapy, cryotherapy or laser treatment can cure small lesions.

Adults

Malignant melanoma is the most common tumour, and it originates in the pigment cells of the choroid ciliary body (Fig 36.13 and Fig. 36.14) or iris. It can present a reduction in vision, a vitreous haemorrhage or by the chance finding of an elevated pigmented lesion in the eye. Growth can be rapid or fairly slow; as a general rule, the more posterior the lesion the more malignant it is likely to be. Malignancy is ultimately related to the cell type. Spread is often delayed for many years, and often goes to the liver, hence the advice ‘beware of the patient with a glass eye, and an enlarged liver’. Treatment is by light or laser coagulation, radioactive plaques, radio­therapy, enucleation and in selected cases it is by local excision using hypotensive anaesthesia. Note: a blind painful eye may hide a malignant melanoma. Diagnosis is made either by direct observation or by ultrasound which shows a solid tumour (Fig. 36.15).