This document discusses different types of intraocular tumours: 1) Uveal tract tumours including iris melanomas, ciliary body melanomas, and choroidal melanomas. Choroidal melanomas are the most common type of uveal melanoma. 2) Retinal tumours such as retinoblastoma, which is the most common primary malignant intraocular tumour in childhood. 3) Metastatic tumours, which are more common than primary intraocular malignancies and spread from primary cancers such as breast and lung cancers.

1. Intraocular tumours

2. Intraocular tumours
Uveal tract tumours – iris, ciliary body, and
choiroidal melanomas
Retinal tumours – Retinoblastoma
Metastatic tumours

3. Uveal tract tumours
IRIS
• Naevi – Benign – flat to slightly elevated
lesions .
• Melanoma – 5-10% of uveal melanomas – age
50-60 years, elevated and more pigmented
Treatment: local resection +/- radiotherapy –
good prognosis

4. Uveal tract tumours
Iris naevus Iris melanoma

5. Ciliary body melanomas
• 10% of uveal melanomas – only visualised when pupil is
widely dilated.
• Presentation depends on size and location – lens
subluxation or localised lens opacities, sentinal vessels,
erosion into anterior chamber, posterior extension 
retinal detachment.
• Ultrasound may be necessary
• Treatment – enucleation, local resection, radiotherapy
• Prognosis is poor as presentation is usually late

6. Ciliary body melanoma
Picture on left showing black mass in
red reflex
Picture on right showing tumour
pushing on and displacing the lens

7. Choroidal melanoma/ Malignant melanoma
• 85% of uveal melanomas, most common during sixth
decade of life
• Raised pigmented oval shaped mass(occasionally
amelanotic)
• Commonly asymptomatic – found on routine fundal
examination – may cause decreased visual acuity or
defect in visual field – can cause an exudative retinal
detachment, secondary glaucoma, cataract or uveitis

8. Choroidal melanoma MM
Peripheral MM MM at macula

9. Diagnosis of choroidal melanoma
• Ocular ultrasound – gives a measurement of
size of tumour particularly the height, also
differentiates between a normal retinal
detachment (RD) and RD caused by tumour
• MRI of orbits and optic nerves to check for
extra scleral spread
• Fluorescein angiography, shows increased
vascularity and leakage from tumour

10. Differential diagnosis of choroidal
melanoma
• Retinal detachment
• Metastatic tumour
• Neovascular ARMD
• Large choroidal naevus

11. Medical evaluation of patient with
choroidal melanoma
• Exclude a metastatic tumour – lung tumours
in males and breast tumours in females are
the commonest tumours that spread to the
eye
• Detection of distant metastases – choroidal
melanomas spread to the liver and lung
• Chest x ray, abdominal ultrasound, MRI,
mamography

12. Management of choroidal melanoma
• Consider visual acuity of involved eye
• Size, location, extent and apparent
activity of involved eye
• State of fellow eye
• General health and age of patient

13. Treatment of choroidal melanoma
• Radioactive plaques
• Enucleation
• Cyclotron – generated charged particle
radiation
• Photocoagulation
• Trans pupillary thermotherapy
• Localised resection
• Exenteration
• Palliation with chemotherapy

14. Retinoblastoma
• Tumours of primitive photoreceptor cells of
eye.
• Most common primary malignant intraocular
tumour in childhood – one in 20,000 live
births

15. Retinoblastoma
• Average age at diagnosis 18 months –
majority diagnosed by three years of age
• Early treatment can save vision, and the life of
the patient
• Other primary tumours such as sarcomas may
develop in about 10% of patients

16. Retinoblastoma
Children present most commonly with
Leucocoria
and/or
Squint

17. Retinoblastoma
Fundal picture
Pinkish white raised lesions with blood vessels on
surface (may show calcification on Xray)
or
Retinal detachment

18. Left convergent squint and
leucoria

20. Retinoblastoma
• 1/3 are bilateral –these present earlier than
unilateral tumours. Most bilateral tumours are
familial, autosomal dominant. Only 6% of
patients have a positive family history. Patients
with familial retinoblastoma have a 50% risk of
transmitting the disease to their children.
• Sporadic cases usually uni-ocular but can be
bilateral.

21. Retinoblastoma
These tumours spread trans sclerally to orbits,
via the optic nerves to the brain and via blood
to bone marrow
Investigations – ultrasound, CT, MRI,

22. Retinoblastoma
Treatment –
• enucleation,
• radiotherapy (external beam,
plaque),
• thermotherapy,
• cryotherapy,
• chemotherapy

23. Retinoblastoma
Very important
Any child under 5 years of age who has
leucocoria, a squint or loss of vision must be
examined to out rule Retinoblastoma

24. Metastatic Tumours
More common than primary malignancies
Common primary site in women – breast
In men – bronchus
Less common sites kidney, testis, GIT.
May present with decreased visual acuity in one or
both eyes
• Solitary or multiple creamy white placoid or oval
lesions.
• Treatment: Chemotherapy and/or radiotherapy

25. Metastatic tumour from breast cancer