Eye Cancer Symptoms: Early Signs in Adults and Children

Eye cancer symptoms depend on where the tumor grows. A tumor inside the eye may blur or distort vision or cause flashes and shadows; one on the surface shows as a spot or growth; an eyelid cancer usually starts as a lump or sore that does not heal; a tumor behind the eye can push the eye forward; and in young children the most common sign is a white reflection in the pupil. Many eye tumors cause no symptoms at all and are found during a routine eye examination.

None of these signs means that you have cancer, as each has far more common causes, but some should be checked quickly. This guide explains the early signs of eye cancer by location and age, and how urgently to act.

Can eye cancer cause no symptoms at all?

Yes, and this is common. About 30% of uveal melanomas, the most frequent cancer inside the adult eye, are found during a routine dilated eye examination before the person notices anything. A choroidal nevus, the harmless "freckle" from which some melanomas arise, is discovered the same way. Regular eye checks with dilated pupils or wide-field retinal photographs are therefore worthwhile even when your vision seems perfect.

What symptoms can a tumor inside the eye cause?

Tumors inside the eye, such as uveal melanoma, choroidal metastasis or vitreoretinal lymphoma, cause symptoms when they affect the retina, leak fluid or bleed:

• Blurred or distorted vision: straight lines look wavy, or one eye gradually loses sharpness. Reduced vision is the first symptom in about 38% of people with uveal melanoma, and blurred vision is reported by about 70% of people whose eye tumor has spread from a cancer elsewhere in the body.
• Flashes of light and floaters: reported by about 9% and 7% of people with uveal melanoma.
• A shadow or a missing part of the visual field, often at the edge of vision (about 6%).
• Floaters and haze that look like inflammation: vitreoretinal lymphoma can imitate uveitis in middle-aged and older adults, and it affects both eyes in 80–90% of cases.

A melanoma of the ciliary body, hidden behind the iris, may stay silent until it is large; enlarged blood vessels on the white of the eye, lens changes or raised eye pressure can be the first clues.

What does a new spot on the iris mean?

Freckles and nevi on the iris, the colored part of the eye, are common and usually harmless. An examination is worthwhile if a spot is new in adulthood or growing, if the pupil changes shape, or if there is bleeding in the front of the eye or raised eye pressure. In a series of 317 eyes with iris melanoma, the pupil was distorted in 45% and the eye pressure was raised (glaucoma) in 35%. Iris melanoma has a much better outlook than melanoma deeper inside the eye.

What does a tumor on the white of the eye look like?

Growths on the conjunctiva, the thin membrane over the white of the eye, are often visible in the mirror. Most are harmless: a pinguecula (a yellowish bump beside the cornea), a pterygium (a wing of tissue growing onto the cornea) or a conjunctival nevus. Signs that a conjunctival tumor needs a specialist include:

• a gelatinous, grayish or white, crusty patch where the white of the eye meets the cornea, the site of about 95% of early squamous lesions (OSSN);
• a new or changing brown patch in an adult, or a pigmented or pink nodule with prominent blood vessels (conjunctival melanoma);
• a smooth, salmon-pink patch, often in the fold under the eyelid, which can be a lymphoma;
• growth, bleeding, a lesion that seems fixed to the eye, or one-sided redness that does not settle with treatment.

Which eyelid changes can be a sign of cancer?

Most eyelid lumps are chalazia (blocked oil glands), cysts or other benign growths. Basal cell carcinoma, about 80–90% of eyelid cancers, usually appears on the lower lid or near the inner corner as a firm, pearly bump with tiny surface vessels, sometimes with a central crust or ulcer. See a specialist if an eyelid lesion:

• bleeds, crusts or ulcerates and does not heal, or keeps growing;
• causes eyelashes to fall out or changes the shape of the lid margin;
• is a "chalazion" that returns in the same place, or comes with persistent redness of one eye: sebaceous gland carcinoma can imitate both, which is why recurrent chalazia should be examined under the microscope;
• is a fast-growing, purple-red nodule in an older adult, which can be a rare but aggressive Merkel cell carcinoma.

The eyelid cancer page explains diagnosis and treatment.

What symptoms can a tumor behind the eye cause?

Tumors in the orbit, the eye socket, press on the structures around the eye. Typical signs are a bulging eye (proptosis) or an eye that sits lower, higher or to one side; double vision; a swollen or drooping eyelid; blurred vision if the optic nerve is compressed; and pain or numbness of the forehead or cheek.

In adults, the most frequent cause of a bulging eye is thyroid eye disease, not a tumor. In a child, a bulge that develops over days or weeks needs imaging the same week: rhabdomyosarcoma, the most common orbital cancer of childhood, causes rapidly progressive bulging in 80–100% of cases and is often mistaken for an infection or injury. See orbital tumors.

What are the signs of eye cancer in children?

The main childhood eye cancer, retinoblastoma, is usually found in the first years of life; about two-thirds of children are diagnosed before age 2. In children younger than 5, the first sign is:

• a white pupil (leukocoria) in about 60%: a white or yellowish glow instead of the normal red reflex, often noticed first in a flash photograph (see white pupil in photos);
• a squint (strabismus) in about 20%: an eye that turns in or out because the tumor affects central vision;
• less often, a red, painful or swollen eye, an enlarged eye or poor vision.

Other warning signs are a rapidly bulging eye, unexplained bruising around the eyes, a difference in color between the two irises and, in a baby, a red-purple eyelid swelling that grows over weeks (usually a benign hemangioma, which can still affect vision). Every child with a new squint should have a dilated eye examination.

Which eye cancer symptoms need urgent attention?

Many of the symptoms above only need an examination at the next available appointment, but some should not wait.

The table is a general guide to how quickly to act; it does not replace advice from your own doctor.

What happens at the examination?

If you have eye tumor symptoms, an ocular oncologist examines both eyes with dilated pupils and records any lesion with photographs, ultrasound and OCT, so that it can be measured and compared later; how eye tumors are diagnosed explains each test. If you live abroad, images taken locally can be sent for a remote second opinion. Prof. Türkoğlu sees adults and children, and the eye cancer overview introduces every tumor type.