Tests for eye cancer

You usually have a number of tests to diagnose eye cancer. Eye cancer is also called ocular cancer. This is because ocular is the medical name for the eye.

The tests you might have to diagnose eye cancer include:

• an eye examination

• ultrasound scan

• a test to look at the blood vessels in your eye. This is a fluorescein angiogram

Tests your optometrist or GP might do

Most people with eye cancer are diagnosed after having a routine eye test done by an optometrist.

An optometrist is a healthcare professional trained to examine eyes. They can identify conditions that affect the eye and refer you to a doctor who specialises in treating eye problems. This is an ophthalmologist.

Some people may also see their GP if they have symptoms that could be due to eye cancer.

If you see your GP, they may examine your eye using a handheld device called an ophthalmoscope. This shines a light into the back of your eye.

After your examination, your GP may refer you to a specialist. This is usually an ophthalmologist or a specialist eye cancer doctor (an ocular oncologist).  

Tests your specialist might do

Your specialist usually does more tests. These might include:

• an eye examination

• an ultrasound scan of the eye

• a fluorescein angiogram

• taking a sample of tissue called a biopsy

• blood tests

Eye examination

Your specialist examines your eye using different instruments. They might use:

• an ophthalmoscope

• a slit lamp

Before having an eye examination, you may have eye drops that enlarge the pupils. This makes it easier for the specialist to look in your eyes.

Ultrasound scan

An ultrasound scan uses high frequency sound waves to create a picture of a part of the body. You usually have them in the hospital imaging department.

An eye ultrasound scan uses a small instrument called a probe. Your doctor or other trained healthcare professional puts a clear gel over your closed eyelids and moves the probe gently over them.

Sometimes, your doctor puts the probe directly over the surface of your eyes (the conjunctiva). For this, you usually have local anaesthetic drops put into your eyes. The drops can sting a bit, so you may have some discomfort for a few minutes.

The anaesthetic drops can cause blurred vision for a few hours, so you shouldn’t drive after having this test.

Fluorescein angiogram

A fluorescein angiogram is a test to look at the blood vessels in your eye.

Your doctor puts a yellow coloured dye called fluorescein into a vein in your arm or hand. The dye travels through your bloodstream to the blood vessels in your eyes. Your doctor then takes pictures of your eyes as the dye passes through.

Your doctor may also take photos of the surface of the inside of your eye (the fundus) at the same time. This is called colour fundus photography.

Biopsy of the eye

You may have a sample of tissue or fluid taken from your eye. This is a biopsy. Your doctor sends this sample to the laboratory where a specialist doctor called a pathologist looks at it under a microscope.

You usually have a biopsy of your eye in the operating theatre. You may have a local or general anaesthetic. A general anaesthetic means that you are asleep and won’t feel anything.

To have the biopsy, your doctor puts a thin needle attached to a syringe into your eye. They then draw out some cells.

Blood tests

Blood tests can check your general health including:

• how well your liver and kidneys are working
• the number of blood cells in your blood such as white blood cells,  platelets and red blood cells.  You may hear this being called a full blood count
• if you have any signs of infection

Other tests you might have

You might have other tests depending on the type of eye cancer your doctor thinks you have. There are different types of eye cancer. This includes:

• lymphoma of the eye (ocular lymphoma)

• melanoma of the eye (uveal melanoma)

Tests you might have to diagnose lymphoma of the eye

You might have other tests if your doctor thinks that you have lymphoma of the eye.

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. It gives detailed information about your cancer. You have a PET-CT scan in the radiology department. It usually takes between 30 and 60 minutes.

A PET-CT scan can check whether there are any cancer cells in the lymph nodes close to the eye or elsewhere in your body.

Lumbar puncture

A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord . This fluid is called the cerebrospinal fluid or CSF.

Your doctor puts a thin needle into your back. They then take a sample of the cerebrospinal fluid. You usually have this test in the outpatient department under local anaesthetic.

Bone marrow test

You may have a bone marrow test to check whether the lymphoma has spread to your bone marrow. The bone marrow is the spongy tissue inside your bones that makes blood cells.

A doctor or specialist nurse removes a sample of bone marrow cells to look at under a microscope. This is usually from the hip. 

Tests you might have to diagnose melanoma of the eye

You might have other tests if your doctor thinks that you have melanoma of the eye.

Liver ultrasound

Melanoma of the eye can spread to the liver. So you might have an ultrasound scan of the liver to check for any cancer spread.

Genetic testing

If you are diagnosed with eye melanoma, your doctor may ask a pathologist to test the cancer cells for changes in the chromosomes. This is called cytogenetic testing.

Chromosomes are found in the centre of all cells. Cytogenetic testing gives doctors information about the chances of your cancer coming back or spreading. This can help your doctor plan your treatment and follow up.

Other scans

Depending on your situation, you might have other scans such as an MRI scan or a CT scan. These scans help your doctor find out whether the cancer has spread:

• outside of the eye

• to nearby lymph nodes

• elsewhere in the body

Treatment

The tests you have help your doctor find out if you have eye cancer and how far it has grown. This is the stage of the cancer.

This is important because doctors recommend your treatment according to the stage of the cancer.

Coping

Coping with a diagnosis of eye cancer can be difficult. There is help and support for you and your family.