Side effects of radiotherapy for eye cancer
There are a number of possible short and long term side effects when you have radiotherapy for eye cancer. There are different ways of giving radiotherapy to the eye.
- Internal radiotherapy (brachytherapy) - a small radioactive disc is stitched to the eye. This gives a high dose of radiation to the eye cancer.
- External beam therapy - for this treatment a machine directs radiotherapy beams at the cancer from outside the eye.
Possible side effects depend on:
- the dose of radiotherapy
- the type of radiotherapy
- which part of your eye is treated
Some of the more common side effects are listed below. You may not have all of these. Your eye specialist will go through the possible side effects specific to your treatment.
Short term side effects
The possible short term side effects are:
Loss of eyelashes
Your eyelashes should grow back after your treatment, although this may not happen straight away. Until they do grow back, some people wear false eyelashes.
Increased pressure in the eye
Temporary swelling can cause the pressure inside your eye to rise. Until your treatment is over you have to use eye drops and possibly take steroid tablets to treat this. Laser therapy may be necessary if other treatments do not work.
Feeling tired
You are likely to feel quite tired for a few weeks after your radiotherapy. This is normal but can be frustrating. People tend to think they should have their energy back because their treatment has finished.
What you can do to help:
- daily light exercise such as walking
- have a healthy balanced diet
- rest regularly throughout the day
In time you may notice you are more active and need less rest. Getting back to your usual activity can take time.
Redness around the eye
The skin around the eye can sometimes look red, inflamed and feel sore. You might notice that you have watery eyes. This may not happen until your treatment has finished, and it could last for a few weeks. Gentle washing with water that has boiled and allowed to cool can help. Do ask your radiographer or nurse about caring for your eye. They might recommend a cream you can put on the area.
Sometimes you are prescribed steroid or antibiotic eye drops to treat this. You can also take painkillers to reduce the discomfort.
Sunlight can irritate the eye, so wearing dark glasses when you go outside might feel more comfortable.
Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to, but there are some general side effects you might experience regardless of where your cancer is. This video is about the general side effects you might have.
On screen text: Tiredness and weakness
Martin (Radiographer): As the normal cells repair themselves from the treatment this can use a lot of the body's resources, causing tiredness.
David: After about four weeks, I started to get tired. The body was starting to weaken.
Laurel: I was tired, day and night. Getting up in the morning was like a chore. I couldn't talk for 5 minutes. I would just sleep and just sleep and just wake up and sleep again.
Martin (Radiographer): Listen to your body. Take rests if you need to. Try not to overdo things.
Laurel: Don't fight with yourself too much. Just like go at a pace and just work with your body. If you can't make it today, you can't make it today.
David: You've got to rest. You have to take the time to rest.
Mary: Just going for them small walks. They really do help you. And even if it is just walking around your house or just walking around the block.
Martin (Radiographer): Doing exercise can help with tiredness by helping you maintain energy levels.
Mary: Being outside, that's a big, massive thing as well because you're feeling the fatigue and I think getting outside, just getting a bit of fresh air that really, really did help me.
Martin (Radiographer): The tiredness you can expect to begin within the first few weeks of treatment. Once it reaches its peak, about two weeks after treatment it recovers quite quickly after that.
Mary: It's not forever. You're not going to be like this forever and I did have to tell myself that.
Laurel: Two months after treatment, I start to feel less tired and that was a way forward because things start to really improve.
On screen text:
- Rest and have short naps when you need to
- Drink plenty of water
- Eat a balanced diet
- Do some gentle exercise
- Get some fresh air
On screen text: Sore skin
Martin (Radiographer): The radiotherapy can cause soreness of the skin. This only affects the area that you are having treated. This usually starts to appear about two weeks after you start treatment. You may notice this becoming more red and may become more itchy and sore as treatment continues.
David: After about ten days I started to get red on the area that they were targeting and it just progressively got redder and redder.
Laurel: My skin was dry and at the back was just like this triangle shape thing where it was like, okay, I'm a woman of colour, but it was really, really black.
David: Wasn't too painful, it was sort of annoying, rather than painful.
Martin (Radiographer): After treatment’s finished, the skin will remain sore for up to two weeks, but then recovers quite quickly.
Laurel: I haven’t got no scarring now at all.
David: It was maybe three or four weeks and then all the blemishes disappeared front and back.
Martin (Radiographer): When you start treatment we would advise you to carry on with your normal skincare routine but as the side effects develop, then your team will advise you on which products you can use on the skin safely.
Laurel: When I'm washing myself I use a sponge and you're just literally as it were just squirt it down, you don't rub the skin at all because it's already damaged. Pat dry, don't rub.
David: I spoke to the hospital about it and it was them that recommended this cream to put on, just to alleviate the symptoms.
Martin (Radiographer): We'd recommend wearing loose clothing and keeping the treatment area covered up against the sun and wind.
Laurel: I had to change most of my wardrobe. I only wore cotton.
David: Wearing T-shirts, soft clothing, nothing that would rub.
Mary: It's important when you go outside to make sure that you do wear that headscarf, or you do wear a hat or whatever it is.
Laurel: I wouldn't go in the sun at all, at all because my skin was - I know it was too delicate.
On screen text:
- Don’t rub the area, press if it is itchy and dab your skin dry
- Don’t use perfume, perfumed soaps or lotions on the area
- Don’t shave the area
- Only use creams or dressings advised by your specialist or radiographer
- Wear loose fitting clothing
- Avoid strong sun or cold winds
- Make sure you wear sunscreen
On screen text: Hair loss
Martin (Radiographer): Radiotherapy can cause hair loss in the area that's being treated, whereas chemotherapy can cause hair loss all over the body.
Mary: 2 to 3 weeks after the radiotherapy, I was brushing my hair and loads came out on the brush. I knew it was going to happen, but it was just hard when it happened.
Martin (Radiographer): In most cases the hair will grow back. This can take a couple of months and the hair may have a slightly different colour or texture.
Mary: Mine did grow back and there's a lot of grey in it so I have to dye it. This is not my original colour. It's very slow growing back.
Martin (Radiographer): Use a simple soap to clean the area. Be gentle with the skin in that area and after washing pat the area dry with a soft towel.
On screen text:
- Radiotherapy can make hair fall out in the treatment area
- It won’t cause hair to fall out in other parts of your body
- Your hair might grow back a few weeks after treatment ends
- If your hair won’t grow back, then your doctor should tell you
- Don’t use perfume, perfumed soaps, or lotions on the area
On screen text: Your mental health
Laurel: I felt frustrated. Some days were really, really challenging where there were just tears without words.
Mary: It's a mixture of emotions. You feel angry and you feel frustrated. You lose your confidence.
Martin (Radiographer): Radiotherapy can cause a lot of emotions at various times during the treatment. You may feel sad or anxious or depressed, which is quite normal. It's good to talk to people about your experiences, whether that's your team at the hospital or friends and family.
David: I couldn't praise the team highly enough. Everybody that was involved were unbelievable and if it hadn't been for them, I just don't think I would have gotten through with it.
Mary: I did have a nurse as well and she had the experience of dealing with people that went through brain surgery, went through radiotherapy so it was just great that I could reach out.
Martin (Radiographer): Your team will be able to give you information about local patient support services that are available, that includes things like counselling and complementary therapies.
Laurel: A referral from the hospital counselling, which I attended for about a year.
Martin (Radiographer): There's also lots of support available online and in your local area.
Mary: I went on loads of different forums and I spoke to loads of different people and it really, really helped me. If I didn't do that, I don't think I would have got through most days.
Laurel: If you get a bit cranky or feel a bit low, go for it. But there's so much help out there and that's why I'm pushing forward like don't sit down in silence. It's the same thing, just get the help you need.
On screen text:
- There is help available – ask the hospital for support
- Talk to your friends and family about how you are feeling
- Ask about local support groups
- Your GP or hospital can provide counselling
- You can get help and support online through forums
If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
On screen text: For more information go to: cruk.org/radiotherapy/side-effects
Long term side effects
Long term side effects can develop within a few months or take many years. Your team will go through what signs to look for and who to contact if you have any concerns. You have follow up appointments to check for any changes.
Some possible long term side effects are:
Cataracts
Radiotherapy to the eye sometimes causes a cataract. This is when your lens becomes misty or fogged, so that you can't see clearly. To try to prevent this your specialist shields your lens from the radiation beam if possible.
A cataract after radiation exposure takes a while to develop, perhaps years. If you do get a cataract, you may have an operation to remove it and put in a new lens.
Dryness of the eye
Dryness of the eye can be a short or a long term side effect. During external beam radiotherapy, the gland that makes tears is shielded from the radiation to reduce this side effect. You can have eye drops (artificial tears) to moisten your eye if dryness becomes a problem.
You may need to use these drops every day to stop the covering of the eye (the cornea) from getting inflamed and sore.
Loss of sight
Radiotherapy can sometimes affect eyesight. It is important to contact your eye specialist or GP if you notice changes in your sight.
Damage to the retina (the inner lining at the back of the eye)
Doctors call this radiation retinopathy. Radiotherapy can damage the retinal blood vessels, causing them to bleed, which affects your eyesight. To treat this, you may have:
- laser treatment
- steroid injections
- surgery
These treatments may help to improve your sight.
It is sometimes possible to reduce the radiation damage and hopefully improve or maintain sight by giving injections of drugs into the eye, such as bevacizumab (Avastin). This is a type of anti-VEGF drug which stops the growth of new blood vessels in the eye. Doctors usually use this type of treatment for an eye condition called macular degeneration.
Optic nerve damage
This is caused by swelling and bleeding of the optic nerve. It can be difficult to treat. Early sight loss cannot be repaired, but it might be possible to prevent further damage. Treatment can include laser therapy and steroid injections into the eye.
Problems with thinking, memory and depression (lymphoma)
If you have radiotherapy for lymphoma, you may have treatment to the brain and spinal cord as well as the eye. Radiation can cause changes to the brain tissue.
This may cause problems with thinking clearly and memory, or depression. This only happens in a small number of adults. If you do develop these side effects, they can appear a few months or several years after you were first treated.
Unfortunately, these late side effects are usually permanent. And occasionally they can become worse over a long period of time.
Seeing a specialist
Let your eye specialist know if you have any of these side effects. It is particularly important to contact your team at the hospital or your GP if you notice any changes in your eyesight. In some cases early treatment can improve some side effects.
