Abstract:
Background. Ocular tumors or metastases of systemic tumors in the eye can lead to increased IOP
and irreversible alteration of ocular structures through several pathogenetic pathways. IOP
elevation is proportional to tumor type, location, and size. Additionally, IOP will increase
depending on the degree of inflammation, necrosis, or bleeding, if any. The prevalence of ocular
metastases in systemic tumors is about 4%. The most common sources are breast, lung and kidney
cancer.
Management of intraocular tumors with secondary glaucoma consists mainly in the elimination of
viable tumor cells. IOP control can be performed conservatively or surgically. The treatment of
secondary glaucoma begins with topical eye drops which decrease aqueous humor production. In
case of inefficiency, systemic therapy with oral hypotensive drugs is started. Prostaglandin
analogues should be avoided, as they increase the amount of melanin in melanocytes and worsen
the prognosis of melanoma. In the case of systemic tumors with ocular metastases, chemotherapy
may have a favorable effect. If the conservative treatment is ineffective, the surgical one is used.
En-block resections of the iris and ciliary body are performed. Transscleral cyclophotocoagulation
or cryotherapy are less invasive methods of IOP control. Glaucoma surgery (incisional, including
filtration procedures and drainage devices) is generally contraindicated due to the increased risk
of spreading tumor cells. Among the effective methods are plaque brachytherapy, external beam
radiation, chemotherapy. In cases with massive uveal melanoma, retinoblastoma, pronounced eye
pain and minimal visual potential, enucleation of the eyeball is used.
Conclusions. The patient's prognosis depends on the type of tumor, the involvement of the eye
structures and the treatment applied. The primary goal of treatment is to control the tumor and then
the IOP.
