Eye Tumor Surgery: What to Expect Before, During and After

Being told you need eye tumor surgery raises practical questions: Will I be awake? How long will it take? When can I travel home? The answers depend on the operation — a small biopsy on the eye surface has little in common with orbital surgery or removal of the eye.

Prof. Türkoğlu performs ocular oncology surgery, including biopsy and tumor removal, eyelid and orbital surgery, and enucleation or evisceration with an implant.

What types of eye tumor surgery are there?

Plaque brachytherapy also involves two short operations — to place a radioactive plaque on the eye and to remove it — performed together with radiation oncology.

Biopsy

Most tumors inside the eye are diagnosed from imaging, without a biopsy (see how eye tumors are diagnosed). When cells are needed — to confirm an unusual diagnosis or for genetic tests on melanoma cells — a fine needle is passed into the tumor, often during plaque placement. Published series report a reliable result in 88–95% of cases; the main risk is bleeding inside the eye, and seeding along the needle track is rare. Retinoblastoma is not biopsied directly, because of the risk of spreading cells. In the orbit, some tumors — such as the benign mixed tumor of the tear gland — should be removed whole rather than cut into, which can seed recurrences.

Surface and eyelid tumors

Conjunctival tumors are removed with a "no-touch" technique — the tumor is not grasped, to avoid shedding cells — with a margin of about 3–4 mm of normal tissue. The edges are frozen (cryotherapy), any corneal part is treated with alcohol, and larger defects are covered with amniotic membrane or a graft (see conjunctival tumors).

For eyelid cancers, the aim is complete removal with clear margins while sparing as much eyelid as possible. In Mohs micrographic surgery, carried out by a Mohs surgeon, the entire margin is examined during the procedure — standard processing examines less than 2% — and the eyelid is rebuilt the same or the next day. Alternatively, a pathologist checks the margins on frozen sections during surgery. Defects of up to a quarter to a third of the eyelid's length can often be closed directly; larger ones need flaps or grafts, sometimes in two stages several weeks apart — which matters for travel plans (see eyelid cancer).

Local resection and orbital surgery

Selected iris and ciliary body tumors can be removed with part of the iris (iridectomy or iridocyclectomy) or, for some, through the wall of the eye — a technically demanding operation (see iris melanoma); for most tumors at the back of the eye, radiation is used instead.

Orbital tumors are reached by the safest route: an eyelid crease, the inside of the eyelid, a small temporary window in the outer orbital bone, or through the nose with ear, nose and throat surgeons. Temporary double vision, a droopy eyelid, numbness or dry eye can follow; vision loss is rare and mainly a concern with tumors near the optic nerve (see orbital tumors).

Enucleation and exenteration

When an eye cannot be saved, it is removed whole (enucleation); in retinoblastoma, a long section of optic nerve is included for the pathologist. An orbital implant replaces the lost volume and is attached to the eye muscles, so the artificial eye can move, though less than a natural eye. Evisceration, which removes only the eye's contents, is not used when a tumor is known or suspected, because tumor cells could be left behind. Exenteration — removal of the eye with the orbital tissues — is reserved for tumors that have invaded the orbit (see enucleation and the artificial eye).

Will I be awake? Anesthesia for eye tumor surgery

• Local anesthesia, often with sedation, is usual for small biopsies and for tumors of the eye surface and eyelid: the area is numb.
• General anesthesia is usual for enucleation, orbital surgery and some larger operations.
• Children are treated under general anesthesia, which is also used for their detailed eye examinations.

How long does eye tumor surgery take?

A small biopsy or surface excision is a short procedure; orbital surgery, enucleation or eyelid reconstruction takes longer, and Mohs surgery takes time because each layer is examined before the next. Your surgeon will estimate the time for your operation; for planning, include recovery from anesthesia and, after general anesthesia, possibly a night in hospital.

What happens on the day of surgery?

1. Beforehand, you receive instructions on fasting, which medicines to take or pause — especially blood thinners — and what to bring, including earlier reports.
2. On arrival, the plan is reviewed with you, the site is marked, and you sign the consent form.
3. The operation takes place under the agreed anesthesia.
4. Afterwards, you rest until the anesthesia wears off; the eye is usually covered with a pad or shield.
5. Going home is often possible the same day after local anesthesia, with someone to accompany you — do not drive. You receive written instructions, medicines and a contact number.

What is recovery like after eye tumor surgery?

Pain is usually modest: most patients describe soreness or a scratchy feeling, controlled with ordinary pain relievers. Recovery depends on the operation:

• after surface surgery, redness and a foreign-body feeling settle gradually, with drops as prescribed;
• skin grafts on the eyelid are held with a small padded dressing for 5–7 days;
• after enucleation, swelling and bruising settle over one to two weeks and the socket lining heals over 4–8 weeks; a clear plastic shell (conformer) keeps its shape until the artificial eye is fitted, about 4–8 weeks after surgery;
• after exenteration, drains stay for 24–48 hours and stitches come out after about a week.

When will I get the pathology results?

With Mohs surgery or frozen sections, the margins are checked during the operation. The final written report takes longer, because the tissue is processed in thin sections, and special stains or genetic tests add time. It confirms the diagnosis, states whether the margins are clear and can reveal features that call for further treatment — for example, after removal of an eye with retinoblastoma, high-risk features such as tumor in the optic nerve behind the eye lead to additional chemotherapy. Ask when to expect results and how they will reach you at home.

Can I fly home after eye tumor surgery?

Usually, yes, once the surgeon has confirmed normal healing. Keep in mind:

• UK aviation medical guidance suggests waiting about one week after operations inside the eye;
• if a gas bubble has been placed inside the eye, as after some vitreoretinal procedures, you must not fly until it has gone — typically about 2 weeks for SF6 gas and 6 weeks for C3F8;
• after longer operations under general anesthesia, ask about the risk of blood clots on a long flight;
• plan later steps — stitch removal, a second stage of eyelid reconstruction or the prosthesis fitting — some of which can be arranged near home.

Patients from abroad can plan these steps before traveling — see international patients.