Eye Cancer Treatment Options: Modern, Eye-Preserving Care

Hearing the list of eye cancer treatment options for the first time can be overwhelming: radioactive plaques, proton beams, lasers, injections, eye drops, operations, new drugs and clinical trials. This page explains in plain language what each of the main ocular oncology treatments does, which tumors it is used for and what it means for the eye, so that you can take an active part in choosing a plan.

The overall picture is encouraging. For most eye cancers, modern eye cancer treatment aims to control the tumor while keeping the eye and, wherever possible, useful vision.

What are the goals of modern eye cancer treatment?

Every plan balances three goals, in this order: control the cancer and protect life, keep the eye, and preserve as much vision as possible.

The move toward eye-preserving treatment rests on solid evidence. In the Collaborative Ocular Melanoma Study (COMS), people with medium-sized choroidal melanoma lived just as long after iodine plaque radiotherapy as after removal of the eye, and 85% of plaque-treated patients still had their eye 5 years later. In a 2026 Dublin study of 310 patients followed for a mean of more than 6 years, local tumor control was about 95–96% after plaque or proton therapy, and about 94–96% of patients kept the eye.

Prof. Türkoğlu evaluates your case, explains the options and plans treatment with you; where a method needs specialized facilities, it is delivered together with the relevant specialist teams — radiation oncology and medical physics, interventional neuroradiology, and medical or pediatric oncology.

Which eye cancer treatment options suit which tumor?

A simplified overview of usual first-line options; individual findings can change the choice.

Observation and imaging surveillance

Not every eye tumor needs immediate treatment. Observation is an active choice when a lesion is benign, when it is not yet clear whether a small pigmented lesion is a nevus or an early melanoma, or when treatment would carry more risk than the tumor, as in some frail, elderly patients. It relies on standardized, repeatable measurements — photographs, ultrasound, OCT and autofluorescence — compared from visit to visit, with longer intervals once a lesion proves stable. Documented growth is the main signal to treat.

Radiation: plaque, proton and stereotactic radiotherapy

Radiation is the most widely used eye-preserving treatment for uveal melanoma, and it also treats retinoblastoma, lymphoma, metastases and some surface, eyelid and orbital cancers.

• Plaque brachytherapy: a small disc carrying radioactive seeds (usually iodine-125 or ruthenium-106) is stitched to the outer wall of the eye over the tumor and removed a few days later. The dose falls off steeply, sparing the rest of the eye. Plaques are planned and placed together with radiation oncology and medical physics teams.
• Proton beam therapy: an external proton beam that stops within the tumor, used especially for large tumors or tumors next to the optic nerve; small markers stitched to the eye guide the beam. Relatively few centers worldwide offer it.
• Stereotactic radiotherapy (Gamma Knife, CyberKnife or a linear accelerator): many converging beams in one or a few sessions, without an operation on the eye.
• External beam radiotherapy: for lymphoma, metastases in both eyes and some orbital tumors. It is avoided whenever possible in children with inherited retinoblastoma, because it raises the risk of second cancers.

Tumors shrink gradually, over months. Side effects mainly affect the treated eye: cataract, dry eye and radiation damage to the retina or optic nerve, which can reduce vision months to years later. Several can be treated, for example with injections into the eye or cataract surgery after tumor treatment. External methods are compared on proton therapy and stereotactic radiotherapy.

Laser and light-based treatment: PDT, TTT and photocoagulation

• Photodynamic therapy (PDT): a light-sensitive drug, verteporfin, is given into a vein and activated by a low-energy laser aimed at the tumor, closing its blood vessels. It is the treatment of choice for a symptomatic circumscribed choroidal hemangioma and is used for selected small melanomas and metastases. Because small melanomas can recur after PDT alone, close follow-up is essential.
• Transpupillary thermotherapy (TTT): an infrared laser heats the tumor through the pupil. Recurrences are common when it is used alone, so today it is mainly combined with plaque radiotherapy.
• Laser photocoagulation: for small retinoblastomas at the back of the eye and for retinal vascular tumors, such as the hemangioblastomas of von Hippel–Lindau disease.

Cryotherapy

Cryotherapy destroys tumor cells by freezing them with a fine probe. It treats small retinoblastomas near the front edge of the retina and some retinal vascular tumors. After conjunctival tumors are removed, a double or triple freeze–thaw of the wound edges reduces the chance that stray cells remain. Temporary swelling and discomfort are common afterward.

Local chemotherapy: eye drops, injections and intra-arterial delivery

Delivering chemotherapy straight to the eye concentrates the drug where it is needed.

• Eye drops: 5-fluorouracil, interferon alfa-2b or mitomycin C, in cycles, for OSSN, and mitomycin C or interferon for precancerous pigmentation of the conjunctiva. A 2022 meta-analysis found no significant difference in resolution or recurrence between drops and surgery for OSSN, although the evidence is of low certainty. Redness and stinging are common; general side effects are not expected.
• Intravitreal injections: melphalan or topotecan for retinoblastoma "seeds" in the vitreous gel, and methotrexate or rituximab for vitreoretinal lymphoma. Prof. Türkoğlu was principal investigator of a research project on intravitreal melphalan for resistant or recurrent retinoblastoma, and first author of a 2017 congress presentation on intravitreal rituximab combined with methotrexate for vitreoretinal lymphoma.
• Intracameral injections into the front chamber of the eye: an emerging option, studied so far in small numbers of patients.
• Intra-arterial chemotherapy (IAC): for retinoblastoma, a fine catheter is guided from the groin to the eye's own artery, and chemotherapy such as melphalan is infused directly. Interventional neuroradiologists perform it, with the plan agreed by the ocular and pediatric oncologists. In a Wills Eye series of 341 eyes, 74% were saved at 5 years, with better results for less advanced tumors. See intra-arterial and intravitreal chemotherapy.
• Systemic chemotherapy (vincristine, etoposide, carboplatin) remains important when retinoblastoma affects both eyes, in very young infants and after removal of an eye with high-risk features.

Surgery

Surgery remains central, especially for tumors of the surface, eyelids and orbit.

• Surface tumors are removed with a margin of healthy tissue using a "no-touch" technique, with cryotherapy and, if the cornea is involved, alcohol treatment of its surface; large defects are covered with amniotic membrane or a graft.
• Local resection of selected iris and ciliary body tumors (iridectomy, iridocyclectomy) or, rarely, choroidal tumors is technically demanding and suits only carefully selected cases.
• Eyelid cancers are removed with complete margin control, by Mohs surgery or frozen sections, and the lid is rebuilt with flaps and grafts (eyelid cancer, eyelid surgery).
• Orbital tumors are biopsied or removed through eyelid-crease, conjunctival, lateral or endoscopic approaches, depending on their position (orbital tumors).
• Enucleation, removal of the eye, remains the safest option for very large tumors, optic nerve invasion and blind, painful eyes. An implant is placed during the same operation, and a custom-painted artificial eye is fitted a few weeks later. An eye that may contain a tumor is removed intact; evisceration is reserved for eyes without cancer (enucleation and eye prosthesis).
• Orbital exenteration, removal of the contents of the eye socket, is needed only rarely, for cancers that have spread extensively into the orbit.

Prof. Türkoğlu performs ocular oncology surgery, including tumor excision and biopsy, enucleation and evisceration with implants, and eyelid and orbital surgery. Eye tumor surgery: what to expect describes anesthesia and recovery.

Systemic therapies: immunotherapy, targeted drugs and chemotherapy

When cancer has spread beyond the eye or cannot be controlled locally, treatment that acts throughout the body is given by medical or pediatric oncologists, while the eye continues to be monitored.

• Tebentafusp (Kimmtrak), an approved immunotherapy, directs the body's T cells against uveal melanoma cells in adults with metastatic or inoperable disease who test HLA-A*02:01-positive on a blood test. In its phase 3 trial, 5-year overall survival was 16% with tebentafusp versus 8% with the investigator's choice of therapy.
• Liver-directed treatment, such as melphalan liver perfusion, surgery or ablation, is used for liver metastases in selected patients.
• Checkpoint inhibitors work less well in uveal melanoma than in skin melanoma, but have a role in advanced conjunctival melanoma and in squamous cell or Merkel cell carcinoma of the eyelid.
• Targeted drugs: BRAF and MEK inhibitors for BRAF-mutated conjunctival melanoma, and hedgehog-pathway inhibitors (vismodegib, sonidegib) for advanced basal cell carcinoma, which can sometimes spare the eye and socket from radical surgery.
• Chemotherapy for retinoblastoma, orbital rhabdomyosarcoma and widespread or aggressive lymphoma.

For uveal melanoma, see metastasis and follow-up.

Clinical trials in 2025–2026: what is investigational?

The treatments below are investigational: as of September 2026 they are available only within clinical trials, and their final results are not yet known.

Trials have strict entry criteria and run only at participating centers; ask your specialist whether you might qualify.

How is a treatment plan chosen?

A good plan is made with you, not for you. The main factors are:

• Tumor type and certainty of diagnosis: a lymphoma, a metastasis and a melanoma of the same size are treated completely differently.
• Size and location: thickness and diameter, the distance from the fovea (the center of sharp vision) and the optic nerve, ciliary body involvement and any growth outside the eye.
• Vision in both eyes: when the tumor is in a person's only seeing eye, protecting its sight carries extra weight.
• Age and general health: children need approaches that protect growth and avoid external radiation where possible; for some frail older people, a gentler approach may be wiser.
• Genetics: inherited retinoblastoma (a germline RB1 change) affects treatment and family screening; tumor genetics in uveal melanoma guide follow-up and trial eligibility; the HLA type decides eligibility for tebentafusp.
• Your priorities: how you weigh vision, the number of treatments, travel and time away from home.

1. Records and examination of both eyes, including previous images.
2. Measurement of the tumor with imaging.
3. Staging: a biopsy or body scans where the result would change the plan.
4. Team review with radiation, medical or pediatric oncology when their treatment is involved.
5. Options explained: benefits, risks and effects on vision, in plain language.
6. Your decision, with time for questions or a second opinion.
7. Follow-up with regular examinations and imaging, shared with your doctors at home where possible.

Questions worth asking are collected in how to choose an ocular oncologist, and eye cancer treatment cost in Turkey explains what determines the cost.

What happens after treatment?

Follow-up is part of treatment. The eye is examined and imaged regularly, more often in the first years, to confirm that the tumor is controlled and to catch treatable side effects early. After uveal melanoma, liver scans are scheduled according to individual risk, and children treated for retinoblastoma need long-term survivorship care. All tumor types are introduced on the eye cancer overview.

Treatment guides

• Eye cancer · TreatmentsPlaque brachytherapyA small radioactive disc, stitched to the eye for a few days, treats most eye melanomas without removing the eye. What to expect, step by step.Read more
• Eye cancer · TreatmentsProton & stereotactic radiotherapyProtons, CyberKnife and Gamma Knife are alternatives to a plaque for some eye tumors. How they compare in suitability, sessions and side effects.Read more
• Eye cancer · TreatmentsPhotodynamic therapyA light-activated drug can close a tumor's blood vessels without radiation. Where PDT, thermotherapy and laser fit, and what research shows.Read more
• Eye cancer · TreatmentsRetinoblastoma chemotherapyChemotherapy delivered into the eye's artery or directly into the eye now saves many eyes with retinoblastoma. How each method works.Read more
• Treatments · SurgeryEnucleation & artificial eyeWhen removing an eye is the safest choice: the operation, orbital implants, the custom artificial eye and recovery for adults and children.Read more
• Eye cancer · DiagnosisEye tumor diagnosisMost eye tumors are diagnosed with imaging rather than surgery. What each test shows, when a biopsy is needed and which files to send for review.Read more