Eye Cancer Symptoms: What to Watch For and When to See a Doctor
This guide explains the eye cancer symptoms that patients and caregivers ask about most. It focuses on uveal melanoma (also called intraocular melanoma), the most common primary eye cancer in adults. It also covers retinoblastoma, a very different eye cancer that affects young children, in its own labeled section. If you have a symptom that worries you, do not try to diagnose yourself. Talk with an eye doctor (ophthalmologist), who can do a full eye exam and figure out what is going on.
What Are the Signs and Symptoms of Eye Cancer?
The most important thing to know about uveal melanoma is that it often causes no symptoms at all, especially in its early stages. This surprises many people, who expect a cancer to announce itself with pain or an obvious change. Instead, a small tumor in the eye may sit quietly for a long time without affecting your sight in any way you would notice.
This is especially true if the tumor is not near the center of vision. The retina (the layer of nerve tissue at the back of the eye that senses light) has a small central area called the macula that handles sharp, detailed vision. A tumor growing off to the side, away from the macula, can grow for months or years while your central vision stays normal. Many people only find out they have a growing pigmented spot because an eye doctor happened to look in the right place.
This is why many cases of uveal melanoma are found incidentally, meaning by accident, during a routine dilated eye exam done for something else entirely. A person might go in for a new glasses prescription, a check on early cataracts, or a general vision checkup, and the doctor dilates the pupil with eye drops and notices a suspicious spot on the choroid (the layer of blood vessels behind the retina) or elsewhere in the eye. This is one of the best reasons to keep up with regular comprehensive eye exams, even when your vision feels fine.
When symptoms do occur, they depend heavily on where the tumor is located and how big it has grown. A tumor on the iris (the colored part of the eye) may show up as a visible dark spot you or someone else can see in the mirror. A tumor in the choroid, which is by far the most common location, is more likely to cause blurred vision, a shadow, or flashes of light because it affects the retina lying next to it. A larger tumor is more likely to cause noticeable symptoms than a small one, and a tumor closer to the macula is more likely to affect vision than one farther away.
It also helps to know that most pigmented spots found during a dilated eye exam are not cancer at all. The vast majority are a choroidal nevus, a benign (not cancerous) pigmented spot on the choroid, similar to a freckle inside the eye. If your doctor found a spot and wants to monitor it with follow-up exams and photos, that is a very common and reasonable next step, not a sign that you have cancer. Learn more about how eye cancer is diagnosed and how doctors tell a nevus apart from melanoma.
A Different Disease in Young Children
Retinoblastoma is a different eye cancer that mainly affects young children and works differently from uveal melanoma in almost every way, including its symptoms. Because the symptom pattern for retinoblastoma is so distinct, and because parents searching for information need clear guidance, this guide covers it in its own labeled section below rather than mixing it into the adult symptom list.
What Are the Most Common Symptoms of Eye Cancer?
When uveal melanoma does cause symptoms, certain ones come up more often than others. Here is what they feel like in plain language.
Blurred or distorted vision: A growing tumor can change the shape of the eye or push on nearby tissue, which can blur your sight or make straight lines look wavy or bent. This can come on slowly, so it is easy to blame it on needing new glasses.
A dark spot or shadow in your visual field: Some people describe a fixed dark area, almost like a smudge or a curtain, in part of their vision that does not go away when they blink or rub their eyes.
Flashes of light: Sometimes called photopsias, these are brief flickers or sparks of light, often noticed in dim rooms. They happen when the tumor or associated fluid tugs on the retina.
Floaters: These are small spots, threads, or squiggly lines that seem to drift across your vision, especially against a plain background like a white wall or blue sky. Floaters are also very common with normal aging, so having floaters alone does not mean you have eye cancer, but new or sudden floaters are worth checking.
A new or growing dark spot on the iris: Since the iris is visible from the outside, a spot here may be noticed by you, a family member, or your doctor. A spot that is new, growing, or changing shape deserves an eye exam.
A change in the shape or position of the pupil: The pupil (the dark opening in the center of the eye that controls how much light gets in) can become irregular in shape, or shift slightly out of its usual centered position, if a nearby tumor pushes on it.
Loss of side vision from retinal detachment: A tumor can sometimes cause fluid to build up under the retina, separating it from the back wall of the eye. This is called a retinal detachment, and it can cause a loss of part of your peripheral (side) vision, sometimes described as a curtain coming down from one side.
Eye redness or pain in some cases: Pain and redness are less typical of uveal melanoma than of many other eye conditions, but they can happen, particularly if the tumor is large or has caused increased pressure inside the eye.
If you notice any of these symptoms and they do not go away, it is worth having your eye doctor take a look, even though most of the time the cause will turn out to be something far more common and far less serious than eye cancer.
What Are the Less Common Symptoms of Eye Cancer?
A few symptoms of uveal melanoma show up less often, usually only when a tumor has grown fairly large or has been present for a while without treatment.
Bulging of the eye, medically called proptosis, can occur if a tumor grows large enough to push the eyeball forward in its socket. This is uncommon with uveal melanoma because most tumors are found before they reach this size, but it can happen with tumors that have gone unnoticed for a long time or that have spread outside the eyeball.
Glaucoma, meaning high pressure inside the eye, is another less common symptom. The eye constantly makes and drains a small amount of fluid to keep its pressure normal. A tumor, particularly one on the iris or in the front part of the eye, can physically block this normal drainage pathway or cause new abnormal blood vessels to form that clog the drainage angle. When drainage is blocked, pressure builds up inside the eye, which can cause aching pain, redness, and blurred vision, and can itself threaten vision if not addressed.
It is worth remembering that uveal melanoma is not the only cancer that can affect the eye. Conjunctival melanoma is a separate, rare cancer that starts in the conjunctiva (the thin clear covering over the white of the eye) rather than inside the eye. It often looks like a raised brown or black spot on the white part of the eye and tends to grow faster than uveal melanoma. Eyelid cancers, which include basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, and eyelid melanoma, are usually types of skin cancer that happen to occur on the thin skin of the eyelid, and they typically show up as a visible growth, sore, or thickened area on the eyelid itself rather than inside the eye. These are distinct diseases from uveal melanoma with their own patterns of diagnosis and treatment.
It is also important to know that many small uveal melanomas cause no symptoms at all and are found only on a routine eye exam, as covered earlier in this guide. This is one more reason comprehensive, dilated eye exams matter, even for people who feel their vision is fine.
Retinoblastoma Symptoms
Retinoblastoma is a different eye cancer that mainly affects young children, usually before age 5, and its symptom pattern looks nothing like the adult symptoms described above. Because retinoblastoma occurs in children too young to describe a vision change themselves, parents and pediatricians typically notice something unusual about the child's eye or eyes rather than the child reporting a symptom.
The most common early sign of retinoblastoma is leukocoria, a white or whitish glow in the pupil. Normally, when a camera flash or bright light shines into a child's eye, the pupil reflects back red because of the blood vessels in a healthy retina, which is the familiar "red eye" look in flash photographs. In an eye with retinoblastoma, that reflection can instead look white, dim, or different between the two eyes, because a tumor is blocking the normal reflection. Many parents first notice this white glow while looking through photos on their phone, and this remains one of the most useful early warning signs of retinoblastoma anywhere in the world.
Strabismus is the second most common sign. This means the eyes do not line up together and instead look in different directions, sometimes described as a wandering eye or a crossed eye. Strabismus has many possible causes in children and most of the time is not related to cancer, but it is one of the signs doctors watch for.
Other, less common signs of retinoblastoma include redness of the eye, eye pain (sometimes from a buildup of pressure, called glaucoma, similar in concept to the adult form described above), poor vision, bulging of the eye, an enlarged eye, and heterochromia, meaning the two irises (the colored part of each eye) are different colors from each other. If retinoblastoma has spread beyond the eye, a child might also have loss of appetite, weight loss, headache, or vomiting, though this is less common today because most cases are caught earlier.
Parents who notice a white or unusual reflection in their child's eye in a flash photograph, or who notice their child's eyes do not seem to track together, should have the child examined by a pediatrician or eye doctor promptly. Retinoblastoma is frightening to hear about, but it is important to know that outcomes are generally excellent when it is caught and treated early, and treatment today often saves both the eye and useful vision in many children. This is a separate disease from uveal melanoma in every important way, including its genetics, its treatment, and its outlook, so it should never be confused with the adult condition described elsewhere in this guide.
What Are the Symptoms of Advanced (Metastatic) Eye Cancer?
Uveal melanoma has an important biological feature that sets it apart from many other cancers: it spreads through the bloodstream rather than through the lymph nodes, and it has a strong, well-documented tendency to spread to the liver specifically. This can happen even many years after the original eye tumor was successfully treated, which is different from what many patients expect based on other cancers they may have heard about.
When uveal melanoma spreads to the liver, symptoms can include pain or discomfort in the right upper part of the belly, where the liver sits, unexplained weight loss, fatigue that does not improve with rest, and a loss of appetite. Jaundice, meaning a yellowish color to the skin or the whites of the eyes, can occur if enough liver tissue is affected to slow the liver's normal function. Abnormal results on liver blood tests, which check substances the liver releases into the bloodstream, can also be a sign that cancer has reached the liver.
An important and reassuring point is that liver spread is often found on routine surveillance imaging, such as an ultrasound or MRI of the liver, before any symptoms appear at all. This is exactly why doctors recommend regular, often lifelong, liver imaging and blood testing after treatment for uveal melanoma, even when a patient feels completely well. Finding a small area of spread early, before it causes symptoms, generally allows for more treatment options than finding it later after symptoms have developed. You can read more about this approach in the guide on eye cancer screening.
The liver is by far the most common site of spread for uveal melanoma, but it is not the only one. Less often, uveal melanoma can spread to the lungs or to bone, and symptoms would then depend on that location, such as a persistent cough or shortness of breath with lung involvement, or new bone pain with bone involvement. Your care team will tailor surveillance testing to your individual risk based on factors learned from your tumor at diagnosis. For more on this stage of the disease, see the guides on eye cancer stages and eye cancer treatment.
It is worth repeating one more time that cancer spreading to the eye is a different situation altogether. Cancer that starts somewhere else in the body, most often the breast or lung, and then spreads to the eye is called a metastatic eye tumor or eye metastasis. This is not primary eye cancer, and it is generally treated based on the original cancer type rather than as uveal melanoma. If you are unsure which situation applies to you, ask your care team directly, since the two situations are managed very differently. Whatever your situation, talk with your own doctor or care team about what your specific symptoms and test results mean for you; this guide cannot replace that conversation.