Hearing the word "tumor" about your eye is unsettling. A choroidal hemangioma, though, is a benign growth of blood vessels. It does not spread to other parts of the body and is not expected to turn into cancer. It needs treatment only when it affects vision, and then the usual option is photodynamic therapy (PDT).
A hemangioma is one of the benign intraocular tumors described in the eye cancer guide.
What is a choroidal hemangioma?
The choroid is the layer of blood vessels that lies under the retina and nourishes it. A choroidal hemangioma is a benign cluster of these vessels. Doctors call it a hamartoma: an overgrowth of tissue that normally belongs in that place. There are two forms. A circumscribed hemangioma is a single tumor with clear edges; a diffuse one spreads over a large area.
| Feature | Circumscribed hemangioma | Diffuse hemangioma |
|---|---|---|
| Link to other conditions | None; it occurs on its own | Sturge-Weber syndrome, with a port-wine birthmark on the same side of the face |
| What it looks like | A single orange-red dome, usually near the optic nerve or the center of the retina | A widespread thickening of the choroid |
| Size | Usually 3–7 mm across and 1–3 mm thick | Covers a large area of the choroid |
| Main problem | Fluid under the retina that blurs or distorts vision | Fluid and retinal detachment over time; glaucoma is also part of the syndrome |
| Usual treatment | PDT when vision is affected | PDT; low-dose radiotherapy if PDT is not enough |
Who gets it?
The circumscribed form is usually found between the teenage years and middle age, often when leaking fluid begins to blur vision. It is not inherited.
The diffuse form occurs in Sturge-Weber syndrome. This condition is present from birth and also causes a port-wine birthmark on the face. It arises by chance early in development and is not passed down in families. Glaucoma, raised eye pressure that can damage the optic nerve, is also part of the syndrome. So children and adults with Sturge-Weber syndrome need regular eye examinations throughout life, including eye-pressure checks.
What symptoms does it cause?
Some hemangiomas cause no symptoms and are found during a routine eye examination. Symptoms, when they appear, come from fluid leaking under the retina or into the macula, the center of sharp vision. Watch for:
- blurred central vision;
- distortion, with straight lines looking wavy;
- a shift toward farsightedness (hyperopia), so your glasses no longer seem right.
How is a choroidal hemangioma diagnosed?
Mainly by imaging. Its orange-red color is a helpful clue. The key task is to tell it apart from look-alikes. One is an unpigmented (amelanotic) uveal melanoma. Another is a choroidal metastasis, cancer that has spread from elsewhere in the body. A third is a choroidal osteoma, a benign growth of bone tissue.
| Test | What a hemangioma typically shows | Why it helps |
|---|---|---|
| Ultrasound | High internal reflectivity: bright echoes inside the tumor | Melanoma usually gives low to medium echoes and looks "hollow" |
| Indocyanine green (ICG) angiography | The dye fills the tumor very early and strongly, then "washes out" in later pictures | A pattern that differs from melanoma |
| Optical coherence tomography (OCT), including deep scans | Fluid under the retina and changes in the retina over the tumor | Shows whether treatment is needed and how the tumor responds |
| Autofluorescence and MRI | Supporting information | Useful when the diagnosis is still unclear |
Each test is explained in how eye tumors are diagnosed.
How is choroidal hemangioma treated?
A hemangioma that causes no fluid and no symptoms needs no treatment. It is photographed and checked from time to time. Treatment is advised when fluid threatens or reduces vision.
How does photodynamic therapy work?
PDT is the first choice for a circumscribed hemangioma that affects vision. A light-sensitive drug, verteporfin, is given into a vein in the arm. A special low-energy laser light is then aimed at the tumor through the dilated pupil. The light activates the drug inside the tumor's vessels, which then close. The drug makes your skin sensitive to light for a short time, so you will be told how to protect yourself from bright sunlight afterward.
The tumor usually flattens and the fluid clears within about 3 months. The effect lasts in most patients, though not in all. In a study of 10 patients published in the British Journal of Ophthalmology (2004), every tumor shrank and the fluid under the retina cleared.
8 in 10
Two patients later lost vision because the choroid thinned over time (atrophy). Some tumors need more than one session. See photodynamic therapy for eye tumors.
What other options are there?
| Option | Suited to | What to expect |
|---|---|---|
| Watching | No fluid and no symptoms | Photographs and scans at intervals |
| Photodynamic therapy | Circumscribed tumors that affect vision; diffuse tumors too | Same-day procedure; fluid usually clears within about 3 months; sometimes repeated |
| Radiotherapy (plaque, proton beam or low-dose external beam) | Tumors that do not respond to PDT; diffuse tumors | Partial shrinkage; fluid clears more slowly, sometimes over 6 months or more |
| Thermotherapy, propranolol tablets, anti-VEGF injections into the eye (medicines that reduce leakage from blood vessels) | Selected cases, sometimes together with other treatment | The evidence is more limited |
In Sturge-Weber syndrome, fluid under the retina and retinal detachment (the retina lifting away from the back of the eye) become common over time. PDT can be used, and low-dose radiotherapy is an option when PDT does not control the fluid. Radiotherapy, including plaque brachytherapy and proton beam therapy, is planned and given together with radiation oncology teams.
What is the outlook?
A choroidal hemangioma is benign: it does not spread and is not expected to turn into cancer. How well you see afterward depends mostly on how much the fluid has affected the macula. That is one reason why a new drop in vision should be checked promptly. After successful treatment the fluid occasionally comes back, so regular check-ups continue.
Choroidal hemangioma care in Antalya
Prof. Türkoğlu confirms the diagnosis with a full set of scans and tells a hemangioma apart from melanoma and other look-alikes. She then explains whether watching or treatment suits you better. When treatment is advised, she plans it with you; where a method needs specialized facilities, it is given together with the relevant specialist teams.
If you live abroad, start by sending your ultrasound, OCT and angiography images, and any earlier photographs, for a remote second opinion. The reply says whether the findings fit a hemangioma and whether treatment is advisable now. Travel is covered on the international patients page.
Frequently asked questions
Is a choroidal hemangioma cancer?
No. It is a benign tumor made of blood vessels that does not spread and is not expected to turn into cancer. Treatment is needed only when fluid leaking from the tumor affects vision. Careful imaging matters mainly to make sure it is not mistaken for a melanoma without pigment or a metastasis.
Why is my vision blurred?
The blur comes from fluid leaking under the retina or into the macula, the part of the retina used for reading and recognizing faces. The fluid can also make the eye more farsighted, so your glasses may seem to stop working. Treatment aims to dry the retina and so stabilize or improve vision.
What happens during PDT?
A light-sensitive drug, verteporfin, is given into a vein, and a low-energy laser light is then shone on the tumor through the dilated pupil. The light activates the drug, which closes the tumor's vessels. You go home the same day and are told how to protect your skin and eyes from bright light for a short time.
How well does PDT work for choroidal hemangioma?
It works well for most circumscribed hemangiomas: the tumor flattens and the fluid usually clears within about 3 months. In a published study of 10 patients, every tumor shrank and vision improved or stayed stable in 8 of the 10. The effect lasts in most patients, but some need another session or a different treatment.
Will I need more than one PDT session?
Sometimes. The response is checked with OCT scans over the following weeks and months. A further session is considered if fluid persists or comes back. If PDT does not control the fluid, radiotherapy is the usual alternative, especially for the diffuse type seen in Sturge-Weber syndrome.
Is it linked to other conditions?
The circumscribed type is not linked to any other disease. The diffuse type occurs in Sturge-Weber syndrome, together with a port-wine birthmark on the face and a tendency to glaucoma. People with Sturge-Weber syndrome therefore need regular eye examinations, including eye-pressure checks, from childhood onward.
Is radiation ever needed?
Yes, in some cases: for diffuse hemangiomas and for circumscribed tumors that do not respond well enough to PDT. The options are plaque brachytherapy, proton beam therapy or low-dose external beam radiotherapy. Radiation shrinks the tumor only partly, and the fluid can take 6 months or longer to clear. It is given together with radiation oncology teams.
References
- EyeWiki (American Academy of Ophthalmology). Intraocular Vascular Tumors. eyewiki.org
- EyeWiki (American Academy of Ophthalmology). Uveal Melanoma. eyewiki.org
- Singh et al. [Photodynamic therapy for circumscribed choroidal hemangioma in 10 patients]. British Journal of Ophthalmology, 2004. bjo.bmj.com
- Karaca BÖ, Türkoğlu EB, Doğan ME. Long term results of photodynamic therapy in intraocular tumors. Photodiagnosis and Photodynamic Therapy, 2023;42:103564. PubMed
- Turkoglu EB, Pointdujour-Lim R, Mashayekhi A, Shields CL. Photodynamic therapy as primary treatment for small choroidal melanoma. Retina, 2019;39(7):1319-1325. PubMed