TUMORS OF

THE EYE
ANTONY HALIM

I4061162030
Tumor could be benign or malignant. Benign
tumors grow with clear margin and doesn’t
invade other tissue, benign tumors usually will
not metastasize. Malignant tumor happens when
cells divide uncontrollably and invade other
tissues.
 TUMORS OF
THE EYELIDS
EPIDERMIS
• Stratum corneum
• Stratum granulosum
• Stratum spinosum
• Stratum basale

DERMIS
• Connective tissue and
contains blood
vessels,
• Lymphatics
• Nerve
 BENIGN EPIDERMAL TUMORS
SQUAMOUS CELL PAPILLOMA
• Squamous cell papilloma is a very common benign
epithelial tumour with a variable clinical
appearance
• Narrowbased (pedunculated or ‘skin tag’), pink
broad-based, whitish thread-like (filiform)
hyperkeratotic lesions similar to a cutaneous horn.
• The incidence increases with age; at least some
cases result from human papilloma virus infection.
• Treatment usually involves simple excision, but
other options include cryotherapy and laser or
chemical ablation.
Squamous cell papilloma. (A) Pedunculated ‘skin tag’;
(B) sessile lesion; (C) hyperkeratotic filiform lesion
• Histopathology in all clinical types is similar,
showing finger-like projections of fibrovascular
connective tissue covered by irregular
acanthotic and hyperkeratotic squamous
epithelium .
 MELANOCYTIC NAEVI
Melanocytic nevi are benign neoplasms or hamartomas
composed of melanocytes, the pigment-producing cells that
constitutively colonize the epidermis.
Melanocytic nevi represent proliferations of melanocytes
that are in contact with each other, forming small
collections of cells known as nests.
The clinical appearance and potential for malignant
transformation of naevi are determined by their histological
location within the skin.
• Junctional naevus
• Compound naevus
• Intradermal naevus
Treatment is indicated for cosmesis or for concern about
malignancy
(A) Junctional naevus; (B)
histopathology shows
heavily pigmented naevus
cells at the epidermal /
dermal junction; (C)
compound naevus; (D)
histopathology shows
naevus cells both at the
epidermal/dermal
junction and within the
dermis; (E) intradermal
naevus; (F) histopathology
shows naevus cells within
the dermis separated from
the epidermis by a clear
zone
 XANTHELASMA
• Derived from the Greek  xanthos (yellow)
and elasma (beaten metal plate).
• Xanthelasma are yellowish plaques, soft, with clear
margin that occur most commonly near the inner
canthus of the eyelid, frequently bilateral.
• Typically affecting middle-aged and elderly individuals.
• They may occur in patients with hyperlipidemia in
about one-third of patients.
• Represents collections of lipid-containing histiocytes in
the dermis of the lid.
• Fat in xanthelasmata is mainly intracellular, with
lipid-laden histiocytes (foam cells) in the dermis.
• Aside from the cosmetic flaw, the patients are
asymptomatic.
• Recurrence rate is high in patients with with
persistently elevated cholesterol levels.

Treatment :
1. For small linear lesions, excision is
recommended, as scarring should blend in
with the surrounding eyelid tissue
2. Carbon dioxide and argon laser abration.
 CAPILLARY HEMANGIOMA
• Capillary haemangioma (strawberry naevus) is one of
the most common tumours of infancy.
• The female to male ratio is 3:1
• Facial lesions most commonly occur in the eyelids
• It presents shortly after birth as a unilateral, raised
bright red lesion, which blanches on pressure and may
swell on crying.
• A deeper lesion appears purplish
• Histopathology shows proliferation of varying-
sized vascular channels in the dermis and
subcutaneous tissue
Treatment to accelerate regression of the
hemangioma :
• Intralesional steroid injections
• Radiation therapy
MOLLUSCUM CONTANGIOSUM

• Non-inflammatory contagious infection caused by DNA

viruses
• Pale, waxy, umbilicated nodules
• These lesions are removed with a curettage
 MALIGNANT TUMORS
BASAL CELL CARCINOMA
• Basal cell carcinoma (BCC) is the most common skin
cancer in humans.
• The most common malignant eyelid tumour, accounting
for 90% of all cases, typically affects older age groups.
• Slowly growing and locally invasive but non-
metastasizing.
• Risk factors : chronic exposure to sunlight, carcinogenic
substance.
• The tumour arises from the cells that form
the basal layer of the epidermis, growing
locally and destroys tissue.
• Surgical therapy is the treatment of choice.
Tumor that limited in the eyelid will have a
reconstruction.
• Radiation therapy can be used in patients with
advanced and extended lesions, radiation
therapy is used to shrink the size of tumor to a
smaller size before reconstruction and not make
any disturbance of eyelid function.
 SQUAMOUS CELL CARCINOMA

• SCC is a much less common, but typically more

aggressive than BCC
• It can metastasize into the regional lymph nodes.
• It occurs most commonly in elderly individuals with a
fair complexion and a history of chronic sun exposure.
• The tumour arises from the squamous cell layer
of the epidermis.
• It is composed of variable-sized groups of
atypical epithelial cells with prominent nuclei
and eosinophilic cytoplasm within the dermis

Histopathology shows acanthotic

squamous epithelium and
eosinophilic (pink)
islands of dysplastic squamous
epithelium within the dermis
• Nodular SCC is • Ulcerating SCC has a red
characterized by a base and sharply defined,
hyperkeratotic nodule which indurated and everted
may develop crusting borders but pearly margins
erosions and telangiectasia are not
usually present
Treatment :
• Treatment of choice of squamous cell
carcinoma is complete surgical removal.
 ADENOCARCINOMA
• Arises from the meibomian glands or the glands of Zeis
• The firm, painless swelling is usually located in the upper
eyelid and is mobile with respect to the skin but not with
respect to the underlying tissue
• Treatment of choice is complete surgical removal
 TUMORS OF
THE
CONJUNGTIVA
 CONJUNGTIVAL NAEVUS
• A conjunctival naevus is the most common
melanocytic conjunctival tumour; the overall
risk of malignant transformation is less than
1%.
• The lesion is typically initially noticed in the
first or second decade.
• Compound naevi are characterized by the
presence of naevus cells at the epithelial–
subepithelial junction and within the
subepithelial stroma.
• Junctional naevi consist of nests of naevus
cells at the epithelial–subepithelial junction
They are uncommon.
• Intradermal lesions are confined
subepithelially.
 CONJUNGTIVAL CYSTS
• Conjunctival cysts are harmless and benign.
• They usually take the form of small clear fluid-filled
inclusions of conjunctival epithelium whose goblet cells
secrete into the cyst and not on to the surface.
• Cysts can lead to a foreign-body sensation and are
removed surgically
 CONJUNGTIVAL PAPILLOMA
• Conjunctival papilloma are strongly associated with
human papillomavirus infection, especially types 6 and
11.
• Lesions are sessile sessile (wide base and flattish
profile) or pedunculated (frond-like)
• They are usually solitary but may be multiple.
• Large lesions are treated by excision, sometimes with
cryotherapy to the base and the surrounding area.
 Sessile Pedunculated
papilloma papilloma
• Histopathologically they consist of a
fibrovascular core covered by an irregular
proliferation of non-keratinized stratified
squamous epithelium containing goblet cells.
 OCULAR SURFACE
SQUAMOUS NEOPLASIA

• A visible mass in the eye, sometimes

accompanied by conjunctivitis-type symptoms
• Most tend to develop within the interpalpebral
fissure, particularly at the limbus, although any
part of the conjunctiva or cornea may be
involved
OCULAR SURFACE
SQUAMOUS NEOPLASIA
• Excision and assessment for
completeness of clearance
• Adjunctive measures reduce recurrence
and include topical chemotherapy
• ▫ Topical agents include mitomycin C, 5-
fluorouracil and interferon alfa-2b eye drop
regimens
 KAPOSI SARCOMA
• Typically found in patients with AIDS, but
occasionally in the elderly and when there is
long-term immunosuppression
• A vascular bright red or purplish plaque or
nodule is seen, sometimes resembling (or
associated with) conjunctival haemorrhage.
• Systemic AIDS therapy should be optimized, with
local radiotherapy, excision and local or systemic
chemotherapy as additional options.
KAPOSI SARCOMA

Conjunctival Kaposi sarcoma

TUMORS OF
THE
IRIS
 IRIS NEVUS
• Proliferation of melanocytes in the superficial
iris stroma, and appear as a circumscribed
solitary flat or variably elevated pigmented
lesion
• The malignant transformation rate is up to
8% over 15 years
▫ Risk factors of malignancy include young
age (under 40), inferior location, bleeding
from the lesion and diffuse iris involvement
 IRIS MELANOMA
• A pigmented or non-pigmented nodule at least
3 mm in diameter and 1 mm thick, typically
located in the inferior half of the iris and often
associated with surface blood vessels.
• Enlargement of a pre-existing naevus is typical,
noticed either by the patient or at a routine eye
examination.
▫ Signs indicative of malignant transformation
include growth and the development of prominent
blood vessels
 IRIS MELANOMA

• Chronic sunlight exposure is an environmental

risk factors.
• Presentation is typically in middle age, a decade
earlier than ciliary body and choroidal melanoma
 TUMORS OF
THE
CILIARY BODY
 CILIARY BODY MELANOMA

• Presentation is usually in the sixth decade

with visual symptoms, although
occasionally discovery is incidental; diagnosis
may be delayed as the lesion is easily missed.
• Overlying prominent episcleral (sentinel)
vessels
• Erosion through the iris root may mimic
iris melanoma, extraocular extension through
scleral vessels a conjunctival melanoma
• Displacement of the lens may cause
astigmatism, subluxation or cataract
CILIARY BODY MELANOMA
• Iridocyclectomy or
sclerouvectomy for small
or medium sized tumours
• Radiotherapy
• Enucleation
TUMORS OF
THE
CHOROID
 CHOROIDAL MELANOMA

• Symptoms are often absent, with a tumour

detected by chance on routine fundus
examination
• A solitary elevated subretinal grey-brown or
rarely amelanotic dome-shaped mass
▫ About 60% are located within 3 mm of the optic
disc or fovea.
• Clumps of overlying orange pigment are
common
 CHOROIDAL MELANOMA

• Treatment is performed to avoid the

development of a painful and unsightly eye
whilst conserving as much useful vision as
possible.
• Management is individualized based on the
characteristics of the particular tumor and the
patient (e.g. general health, age, preferences,
state of fellow eye).
 CHOROIDAL MELANOMA

• Treatment includes brachytherapy, radiotherapy,

thermotherapy and enucleation
TUMORS OF
THE
RETINA
 RETINOBLASTOMA
• A retinoblastoma is a malignant tumor of early
childhood that develops from immature retinal
cells.
• Retinoblastoma occurring in approximately one
of 20.000 births. In 30% of all cases, it is
bilateral
• Retinoblastoma is caused by RB1 gene
mutations, which located at chromosome 13q14
and protein code pRB that helps supress tumor
formation. pRB is a nukleoprotein which located
at DNA and control the cell cycle at transition
phase in G1 to S.
Clinical Manifestation :
• Leukokoria
• Strabismus
• Hipopion
• Hifema
• Decreased visual acuity
• A grayish white, vascularized retinal tumor will be
observed on ophthalmoscopy.
• In its advanced stages, this tumor was formerly
referred to as an amaurotic cat's eye.
• Retinoblastomas may exhibit outward (exophytic) or
inward (endophytic) growth or a combination of both.
• Radiographs or CT images that show calcifications
can therefore help to confirm the diagnosis in
uncertain cases.
Fundus appearance of an Endophytic retinoblastoma with
endophytic retinoblastoma tumor cells seeding the vitreous.
Treatment :
• Brachytherapy using a radioactive plaque can be
utilized for an anterior tumour if there is no vitreous
seeding, and in other circumstances such as
resistance to chemotherapy.
• Chemotherapy. Systemic chemotherapy will reduce
the tumor size, then could use focal combination, such
as laser therapy. Nowadays, there are a lot
combination of regimen, such Carboplatin,
Vincristine, Etoposide dan Cyclosporine.
• Cryotherapy using a triple freeze–thaw
technique is useful for pre-equatorial tumours
without either deep invasion or vitreous
seeding.
• Enucleation is generally indicated if there is
neovascular glaucoma, anterior chamber
infiltration, optic nerve invasion or if a tumour
occupies more than half the vitreous volume.
 CAPILLARY HEMANGIOMA

• Tumors may be detected by screening or

because of symptoms due to macular exudates
or retinal detachment.
• Early tumors appear as small red oval or round
lesions located between an arteriole and venule
• A well-established tumor is seen as a round
orange-red mass
CAPILLARY HEMANGIOMA

• Observation is advised for asymptomatic

hemangioma
• Laser photocoagulation, cryo- and brachytherapy
CAVERNOUS HEMANGIOMA

• The lesions are frequently detected by chance.

• Clusters of saccular aneurysms resembling a
‘bunch of grapes’ with associated greyish
fibrous tissue.
• Because of sluggish flow of blood, the red cells
may sediment and separate from plasma, giving
rise to ‘menisci’ or fluid levels within the lesion.
 CAVERNOUS HEMANGIOMA

• Vitrectomy may be necessary for non-absorbing vitreous

hemorrhage
▫ Photocoagulation should be avoided as it may
precipitate hemorrhage and enlargement of the tumor
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