Definition

A tumor is characterized by abnormal tissue growth, where cells that should have stopped proliferating or undergone apoptosis continue to multiply and enlarge. Tumors can be classified into two types, they are benign tumors and malignant tumors. Benign tumors increase in size but do not spread or metastasize to surrounding tissues or other distant organs. Although benign tumors in the eye are generally not life-threatening, they can lead to vision loss or displacement of the eyeball. The three most common benign eye tumors are choroidal hemangioma, nevus, and cavernous hemangioma.

Causes

Several factors contribute to the development or increase the risk of benign eye tumors, such as prolonged exposure to sunlight and wind. Age-related changes and degenerative processes in the eye can also be significant contributors. The common causes of benign eye tumors include:

1. Choroidal Hemangioma

This tumor involves the abnormal growth of blood vessels in the choroid or retina. It can be categorized into circumscribed, with well-defined borders, and diffuse, which lacks clear borders. The diffuse type is often associated with congenital conditions like Sturge-Weber syndrome. These tumors grow slowly within the choroidal blood vessel walls.

2. Nevus

This benign pigmented tumor appears darker than the surrounding tissue and can occur in the conjunctiva, iris, and choroid (this part is located behind the eyes and has blood vessels and nerves behind the eyes). The risk of a nevus transforming into a malignant tumor is approximately 1%.

3. Cavernous Hemangioma

Typically located behind the eyeball, this benign tumor can cause the eye to protrude (proptosis) and exert pressure on the optic nerve, potentially leading to nerve damage. Cavernous hemangiomas are frequently found in middle-aged women.

Risk Factor

The exact causes and risk factors for benign eye tumors remain largely unknown. For nevus, the known risk factors include age, congenital skin disorders, and UV ray exposure.

Symptoms

1. Choroidal Hemangioma

Symptoms caused by this tumor can manifest from adolescence to adulthood, including visual impairments such as visual field defects and floaters. Other symptoms include refractive errors and eye pain, though intraocular pressure typically remains normal. Tumors are visible on funduscopic examination.

2. Nevus

Generally asymptomatic, a nevus in the eye can cause visual field defects, such as floaters, darker spots that increase in size, blurred vision, and peripheral vision loss.

3. Cavernous Hemangioma

This tumor is typically asymptomatic unless complications arise. Symptoms that can occur include bleeding in the eye chamber or tumor-induced pressure on the eye. Fundoscopy may reveal multiple aneurysms resembling grapes, and the disorder can affect the optic nerve.

Diagnosis

In the process of examining a suspected tumor, it is crucial to determine the location and size of the tumor as a reference in deciding the treatments for each patient. Various diagnostic procedures can be employed to help diagnose benign eye tumors, namely:

• Fundoscopy: This examination is used to inspect the retina, where choroidal tumors often present as oval-shaped masses that may merge with other eye structures.
• Ultrasonography (USG): Ultrasound helps determine the tumor's location and its spread to other parts of the eye.
• Optical Coherence Tomography (OCT): OCT provides detailed images of the retina, aiding in the assessment of retinal conditions.
• Magnetic Resonance Imaging (MRI): MRI offers a clearer view of how the tumor affects the surrounding tissues.

Management

The primary goal in managing benign eye tumors is to prevent blindness. Treatment options include:

• Photodynamic therapy: This treatment uses light-sensitive drugs and specific light wavelengths to destroy tumor and precancerous cells.
• Transpupillary thermotherapy: This laser therapy increases the tumor temperature in the eye, effectively killing them and reducing tumor size.
• Photocoagulation: Laser therapy and specific lenses are used to target and damage tumor cells.
• Radiotherapy: This treatment option can be used to tumors that cannot be surgically removed or are resistant to other therapies.
• Intravitreal anti-VEGF therapy: Medication is injected into the eye to treat retinal complications, often used as adjunctive therapy.
• Propranolol: Used in specific cases, particularly those involving retinal disorders.

Complications

Benign eye tumors typically grow slowly, with symptoms often occuring only if complications arise, such as retinal symptoms or increased intraocular pressure. Potential complications include:

• Glaucoma: Increased intraocular pressure can cause red eyes, vision issues, and eye pain.
• Blindness: Retinal damage from benign tumors can lead to blindness.
• Proptosis (bulging eyes): Tumor growth can push the eyes forward, resulting in a bulging appearance.

Prevention

In certain cases, benign eye tumors are associated with hereditary or genetic factors. Particularly nevus, preventive measures include using protective eyewear to shield the eyes from UV radiation.

When Do You Have To Go To A Doctor?

Seek immediate medical attention if you experience any of the following symptoms:

• Sudden double vision.
• Headache accompanied by sudden vision disturbance or vision loss.
• Prominent or bulging eyes.

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