Find out about the different types of surgery for eye cancer.
Eye surgery is a very specialist area. This section does not discuss all the details of the operations.
Before your surgery, your ophthalmologist (eye surgeon) will discuss the operation with you and explain how it may affect you afterwards.
Ask questions as often as you need to, especially about your sight and appearance after the operation.
If you only need a small operation, you may not lose the sight in your affected eye. If your surgeon needs to remove your eye (an enucleation), then you will lose the sight in that eye.
Removing the tumour
Using surgery to remove a tumour from the eyeball is known as a tumour resection. You often have it in combination with radiotherapy. For large melanomas of the eyeball, this operation is very difficult.
The operation involves opening your eyeball. That means there is a risk of cancer cells breaking away from the tumour and floating into the surrounding eye tissue.
After removing the tumour the surgeon has to put the wall of the eyeball (the sclera) back in place. More than half of all large eye melanomas have already spread into the sclera before the time of surgery. In this case, your surgeon may not be able to remove all of the cancer without removing the eye.
During the operation there is also a risk of:
- your retina becoming detached
- damage to the lens of the eye, causing cataracts
- bleeding (haemorrhage)
Removing part of the eye
Depending on where the tumour is, there are several operations surgeons can use to remove parts of the eye:
- iridectomy – this means removing part of the iris and is used for very small melanomas of the iris
- iridotrabeculectomy – removing the iris and the tissues around the clear layer covering the front of the eye (the cornea), used for small melanomas of the iris
- iridocyclectomy – this means removing the iris and the ciliary body (the muscle that focuses the eye) and is used to treat small melanomas of the iris
- choroidectomy – this means removing part of the choroid
Removing the whole eye
The operation to remove your eyeball is called an enucleation. This is often necessary for large eye melanomas. Your specialist would only suggest this if it is necessary.
Your surgeon will remove your eyeball but leave your eyelids, brow and the surrounding skin in place. In most cases, during the operation your surgeon will fit a permanent eye implant into the socket.
With advances in surgery and the types of eye (orbital) implants now available, better eye movement is possible. Some weeks after your surgery you will have an artificial (false) eye, called an eye prosthesis, fitted over your implant.
This will be specially made for you, to match your other eye. There may be some situations where using an eye implant is not possible, and you will have only an artificial eye.
Eye implants and artificial eyes
The difference between an eye (orbital) implant and an artificial eye can be confusing.
An eye implant is often put in as part of the surgery to remove your eye. The implant is usually round like a ball (spherical) and helps to fill some of the volume where your eyeball once was.
It helps keep the structure of the eye socket and supports the artificial eye, which is fitted later. The implant is surrounded by the tissue around the socket and can’t be seen by anybody.
It is sewn in place into the tissues of the socket of the eye after your surgeon has removed your eyeball. It is permanent and you can’t take it out.
Although artificial eyes have been around for thousands of years, the first eye implant was only made about 100 years ago. Plastic implants have been used for decades and allow some eye movement.
More recently a new type of implant can give better eye movement. These new types of implants are called hydroxyapatite implants. They are made from an artificial form of sea coral. This material is very similar to bone in structure. Blood vessels can grow into it so it can work as part of the normal eye tissue.
An artificial eye
About 6 weeks after your surgery you will have a temporary artificial eye fitted. At the same time you will be measured for an artificial eye made just for you.
The artificial eye is not round like a ball, but more like the shape of a big contact lens. It will have an eye painted onto it to match your remaining eye.
You can take an artificial eye out to clean it whenever necessary. It will move with your eye, although the amount of movement can be limited.