Eye Cancer Treatment: Options for Uveal Melanoma and Retinoblastoma
If you or someone you love was just diagnosed with eye cancer, you may be picturing the worst case right away: losing the eye. That fear is understandable, but it is usually not the reality. Most people with uveal melanoma (also called intraocular or ocular melanoma, the most common primary eye cancer in adults) are treated today with eye-sparing methods that aim to control the tumor while keeping the eye in place. Removing the eye, called enucleation, is generally reserved for the largest tumors, tumors that cause severe pain or blinding glaucoma (high pressure inside the eye), or eyes that have already lost useful vision.
Your treatment plan will come from a team, not just one doctor. An ocular oncologist (a cancer specialist who focuses on eye tumors) usually leads the plan, working closely with a radiation oncologist, and sometimes a retina specialist, a medical oncologist, and an ocularist (a specialist who makes artificial eyes). This team looks closely at your eye cancer stage, including the tumor's size and location within the choroid, ciliary body, or iris, along with results from tumor genetic testing, to recommend the approach most likely to control the cancer while protecting as much vision as possible.
Retinoblastoma is a different eye cancer that mainly affects young children, usually before age 5, and it is treated in a completely different way than uveal melanoma. This guide covers uveal melanoma treatment first, since it is the most common primary eye cancer in adults and the focus of this series, and then covers retinoblastoma treatment in its own clearly marked section below. If your child has been diagnosed with retinoblastoma, you may want to jump directly to that section.
No matter which eye cancer you are facing, this is a lot to absorb at once. Take your time, ask questions, and lean on your care team to walk through what each option means for you or your child specifically. This guide explains the main treatment types in plain language so you can have a more informed conversation with your doctors, but it is not a substitute for their personalized advice.
Types of Treatment for Uveal Melanoma
Doctors choose among several treatment categories for uveal melanoma, and the right one depends on the tumor's size, its location in the eye, whether it is close to the optic nerve or the macula (the part of the retina responsible for sharp central vision), and the results of tumor genetic testing. The main categories are radiation therapy (including plaque brachytherapy and external beam options such as proton therapy), laser treatment, surgery (including both eye-sparing resection and enucleation), and, for cancer that has spread, systemic and liver-directed therapies.
Radiation therapy is the most common treatment for uveal melanoma that has not spread beyond the eye. It works by damaging the DNA inside tumor cells so they can no longer grow and divide, while a well-planned dose tries to limit harm to the surrounding healthy tissue of the eye. Because so many tumors can be treated this way, surgery to remove the eye is not the first option for most patients, contrary to what many newly diagnosed patients fear.
Some very small tumors may be treated with laser therapy alone, and some larger or more complex tumors may need a combination of treatments, such as laser therapy paired with radiation, or surgery followed by radiation. Your ocular oncologist will explain why a particular combination is being recommended for your specific tumor.
For eye cancer that has already spread beyond the eye, most often to the liver, treatment shifts toward systemic therapies that travel through the bloodstream and, in some cases, treatments directed specifically at liver tumors. That situation is covered in its own section below. Whatever combination your team recommends, you have the right to ask about the goals of treatment, the expected effect on your vision, and what alternatives exist, including joining a clinical trial.
Plaque Brachytherapy
Plaque brachytherapy is the most common treatment for small to medium-sized uveal melanomas, and it is a form of internal, or local, radiation therapy. A small radioactive plaque, usually a thin gold dish holding radioactive seeds (most often iodine-125), is custom-sized to match your tumor. The plaque is designed so the seeds face inward toward the tumor, while the gold backing helps shield nearby healthy tissue from radiation.
Placing the plaque requires a short surgery, usually done in an operating room under sedation or general anesthesia. The surgeon sews the plaque onto the outside wall of the eye (the sclera) directly over the tumor. The plaque typically stays in place for several days, commonly under a week, before a second short procedure removes it. Depending on the treatment center and tumor size, some patients temporarily wear an eye patch or shield during this time, and a brief hospital stay may be needed for radiation safety.
Recovery after plaque removal usually involves some soreness, redness, and light sensitivity for a few weeks, along with follow-up visits so your doctor can track the tumor's response and watch for early signs of complications. Most people return to normal daily activities within a few weeks, though full healing of the treated area can take longer.
It is important to be honest about vision after plaque brachytherapy. Many patients keep good vision, especially with smaller tumors farther from the center of the eye. However, radiation can cause vision loss over time from complications such as radiation retinopathy (damage to the retina's blood vessels), cataract (clouding of the eye's lens), or optic neuropathy (damage to the optic nerve), and these effects can appear months or even years after treatment. Vision is often reduced in the treated eye, especially when the tumor sits near the macula or the optic nerve, even though the eye itself has been saved. Your radiation oncologist can give you a more personalized sense of what to expect based on your tumor's exact location and size.
Other Radiation Therapy
For some tumors, doctors recommend external beam radiation instead of, or sometimes combined with, plaque brachytherapy. Proton beam therapy is the most common type used for uveal melanoma. Instead of a radioactive implant inside the eye, a machine outside the body aims a precisely focused beam of protons at the tumor. Charged particle beams like protons can be shaped to deliver a strong, concentrated dose to the tumor while sparing more of the surrounding eye structures than some older external radiation methods.
Before treatment starts, a surgeon places small metal markers (usually tantalum clips) on the outer wall of the eye to help precisely target the tumor during each session. Proton therapy is typically given as a short course of outpatient treatments over several consecutive days, and no plaque or implant is left inside the eye afterward. This approach can be useful for tumors that are large, oddly shaped, or in a location that makes plaque placement difficult, such as very close to the optic nerve.
Like plaque brachytherapy, external beam radiation carries its own set of possible long-term effects, including cataract, dry eye, radiation retinopathy, changes to the eyelashes or eyelid skin, and in some cases glaucoma. Because the beam passes through more of the front of the eye on its way to the tumor, some patients notice more surface irritation or lash loss than they might with plaque therapy, while plaque brachytherapy concentrates more of its effect closer to the tumor itself. Your radiation oncologist will walk you through which side effects are most likely to apply to your specific treatment plan and tumor location.
Laser Treatment
Transpupillary thermotherapy (TTT) is a laser-based treatment sometimes used for very small uveal melanomas. During the procedure, a specialized laser delivers infrared light through the pupil to gently heat and destroy tumor cells, usually without the need for an incision. TTT is generally done in an outpatient setting and may require more than one session to fully treat the tumor.
TTT is sometimes used on its own for carefully selected small tumors, and it is also sometimes combined with plaque radiation therapy, either to treat a small area of remaining tumor after radiation or to help manage fluid buildup under the retina. Because TTT depends on being able to precisely heat the tumor without damaging too much surrounding retina, it works best for tumors that are small, thin, and not right next to the optic nerve or the macula.
Surgery
Surgery for uveal melanoma falls into two very different categories: procedures that try to remove just the tumor while keeping the eye, and enucleation, which removes the entire eye. Local tumor resection, sometimes called eye wall resection, is used in select cases, generally for tumors that are difficult to treat with radiation alone or when a patient and surgeon decide that removing the tumor directly is the best option. This is a more specialized and less commonly performed surgery than radiation therapy, and it is usually done at centers with specific expertise in ocular oncology surgery.
Enucleation is generally reserved for very large tumors that cannot be safely treated with eye-sparing methods, tumors that have caused blinding glaucoma or significant pain, or situations where useful vision in the eye has already been lost. It is important to know that enucleation is not the default treatment for uveal melanoma today; most patients are candidates for an eye-sparing approach. When enucleation is recommended, your surgeon should explain clearly why, in your specific situation, it offers a better outcome than radiation or other options.
Enucleation is typically done as an outpatient or short-stay surgery under general anesthesia, and it usually takes less than an hour. During the same operation, the surgeon places an orbital implant, a round device made of silicone or a material similar to bone called hydroxyapatite, to fill the space left by the eyeball. The implant is attached to the muscles that used to move your eye, so it can move in a similar way once healed.
Within a few weeks after surgery, once the area has healed, you will be fitted by an ocularist (a specialist trained in creating eye prostheses) for a custom artificial eye. This is a thin, curved shell that sits over the orbital implant and under the eyelids, hand-painted to match the size and color of your remaining eye. Many people are surprised at how natural a well-made prosthetic eye can look; once in place, it is often difficult for others to tell it apart from the natural eye, although it does not restore vision.
Losing an eye, or losing significant vision even when the eye is saved, is a real loss that deserves to be acknowledged, not minimized. Grief, anxiety about appearance, and adjustment to changes in depth perception are all common and valid reactions. Many patients find it helpful to talk with a mental health professional, connect with a support group through organizations such as the Ocular Melanoma Foundation or CURE OM, or read more in HealthTree's guide to eye cancer support.
Treatment for Metastatic Uveal Melanoma
Uveal melanoma spreads mainly through the bloodstream rather than through the lymph nodes, and it has a strong tendency to spread to the liver, sometimes many years after the original tumor was successfully treated. When this happens, treatment shifts from local, eye-directed therapy to therapies that reach cancer cells throughout the body, or that target the liver specifically.
Tebentafusp (brand name Kimmtrak) is an important option for some patients with unresectable (not able to be surgically removed) or metastatic uveal melanoma, but it is not for everyone. It is approved by the FDA specifically for adults whose tumor cells carry a particular immune marker called HLA-A02:01. Before tebentafusp can be considered, your care team must order a blood test to check whether you have this marker; patients who test negative for HLA-A02:01 are not candidates for this drug. In a large clinical trial, tebentafusp helped patients with previously untreated metastatic uveal melanoma live longer than those who received other available treatments, and it works by helping the immune system's T cells recognize and attack melanoma cells. Common side effects include skin rash, itching, fever, and a reaction called cytokine release syndrome, which is usually mild to moderate and managed by giving the first several doses in a monitored medical setting.
For patients who are not eligible for tebentafusp, whose disease progresses on it, or who are simply exploring every option, other systemic therapies and clinical trials are important parts of the conversation. Because standard chemotherapy and many drugs used for skin melanoma have not shown strong, lasting benefit in uveal melanoma specifically, clinical trials testing newer immunotherapies, targeted agents, and combination approaches are a meaningful option for many patients with metastatic disease. Learn more about how to explore these options in HealthTree's guide to joining a clinical trial for eye cancer.
When metastatic disease is mostly or entirely confined to the liver, some patients are offered liver-directed therapies. These include chemoembolization (delivering chemotherapy directly into the blood vessels feeding the liver tumors) and immunoembolization (a similar delivery method using immune-stimulating agents), sometimes combined with systemic treatment such as tebentafusp or a clinical trial drug. These liver-focused approaches are generally offered at specialized centers experienced in treating metastatic uveal melanoma, and whether one is right for you depends on how much of the liver is involved and whether disease exists elsewhere in the body as well.
Treatment for Retinoblastoma
Retinoblastoma is a different eye cancer that mainly affects young children, usually before age 5, and its treatment works very differently from uveal melanoma treatment in adults. Retinoblastoma starts in the retina, the light-sensing tissue at the back of the eye, and it is strongly linked to changes in the RB1 gene. Because retinoblastoma can occur in one eye or both eyes, and because tumors in children can range from very small to advanced, treatment is highly individualized and is best delivered at a specialized pediatric eye cancer center.
Systemic chemotherapy, given through an IV so the drugs travel throughout the body, is often used first for retinoblastoma, particularly when the tumor is in both eyes or is too large for local treatment right away. This approach, sometimes called chemoreduction, can shrink tumors enough that gentler, eye-sparing local treatments become possible afterward. Intra-arterial chemotherapy is another option, in which a thin catheter delivers chemotherapy directly through the blood vessel supplying the eye, aiming a higher concentration of the drug at the tumor while limiting exposure to the rest of the body. Intravitreal chemotherapy, in which a very small amount of chemotherapy is injected directly into the vitreous (the clear gel inside the eye), is used for retinoblastoma cells that have spread into the vitreous itself.
Smaller tumors are often treated with focal laser treatment (also called photocoagulation or thermotherapy) or with cryotherapy, which freezes and destroys tumor cells. Plaque brachytherapy, similar in concept to the adult version described above but sized and dosed for a child's eye, may be used for retinoblastoma tumors that do not respond fully to chemotherapy or laser treatment, or for certain tumors from the start. Enucleation is reserved for advanced retinoblastoma in one eye when the tumor is too large or too advanced for the eye to be saved safely, or when there is a risk that keeping the eye could allow the cancer to spread outside it.
Across all of these approaches, the overarching goal is to save the eye and as much useful vision as possible whenever it can be done safely, while making sure the cancer is fully treated. Parents facing this diagnosis should know that outcomes for retinoblastoma are generally excellent with access to good care. In the United States, 5-year survival rates for retinoblastoma that has not spread beyond the eye exceed 95%. This is understandably a frightening diagnosis for any family, but it is also one of the more treatable childhood cancers when caught and managed by an experienced pediatric ocular oncology team.
Side Effects and Life After Eye Cancer Treatment
Life after eye cancer treatment often involves adjusting to some level of vision change, even when treatment is successful at controlling the cancer. Vision loss can come from the tumor itself, from radiation effects such as radiation retinopathy, cataract, or optic neuropathy, or from glaucoma that develops after treatment. Dry eye is also common, especially after external beam radiation, and can usually be managed with artificial tears, prescription eye drops, or other treatments your ophthalmologist recommends. Cataracts that form after radiation can often be treated with cataract surgery, though your doctor will time this carefully around your cancer treatment and monitoring schedule.
Adjusting to reduced vision in one eye, whether from the tumor, treatment side effects, or enucleation, affects depth perception and side vision, which can make some tasks, like judging distances, pouring liquids, or navigating stairs, feel different at first. Most people adapt over time, and low vision specialists and occupational therapists can teach practical strategies and recommend tools such as magnifiers or specialized lighting. If you drive, ask your eye doctor and your state's licensing agency about vision requirements after treatment, since rules vary depending on how much usable vision remains and whether it is affected in one eye or both.
The emotional impact of vision loss or eye loss is real and deserves real support. Feelings of grief, frustration, or anxiety about appearance and independence are common, whether the change is gradual, from radiation effects over time, or sudden, from enucleation. Many patients benefit from connecting with a counselor, social worker, or support group that understands eye cancer specifically, rather than facing these adjustments alone. Low vision rehabilitation programs, often available through hospital eye departments or organizations serving people with visual impairment, can also make a meaningful difference in daily independence.
For survivors of retinoblastoma, one long-term concern deserves special attention: an elevated risk of second cancers later in life. This risk is highest in people with the heritable (inherited) form of retinoblastoma, which is linked to a germline RB1 mutation, and it is further increased by past treatment with radiation therapy, especially when radiation was given before age 1. This is one of the key reasons that genetic counseling and long-term, structured follow-up matter so much for retinoblastoma survivors and their families, not just in childhood but well into adulthood.
Whatever type of eye cancer brought you to this page, it is worth remembering that side effects and adjustments look different for everyone. Some people notice very little day-to-day change after eye-sparing treatment, while others face a more significant adjustment. Talk openly with your care team about what you are experiencing, since many side effects, from dry eye to mood changes, have effective treatments or support options available.
Supportive and Palliative Care for Eye Cancer
Palliative care is specialized medical care focused on relieving symptoms, pain, and stress caused by a serious illness, and improving quality of life for both patients and families. It is important to understand that palliative care is not the same as hospice. Hospice is care specifically for the end of life, typically when curative treatment has stopped, while palliative care can be provided at any stage of illness, including right alongside curative treatment, starting from the day of diagnosis if needed.
For eye cancer specifically, supportive care often includes vision rehabilitation and low vision specialists who can help maximize remaining vision and teach adaptive strategies for daily life. Pain control is another key piece, particularly for patients who have had glaucoma-related pain before enucleation, or who experience discomfort during radiation recovery; your team has many effective ways to manage this and should be asked directly if pain is not well controlled.
Mental health support is a core part of supportive care, not an optional add-on. Living with a rare cancer, facing possible vision or eye loss, or worrying about a child's diagnosis of retinoblastoma can bring on anxiety, depression, or difficulty coping that a therapist, psychologist, or support group can help address. Social workers and financial navigators, often available through your treatment center, can also help with practical concerns such as understanding insurance coverage, finding transportation or lodging for treatment at a specialized center, applying for disability benefits, or connecting with charitable resources for costs like a prosthetic eye.
If your care team has not brought up palliative or supportive care services, it is entirely appropriate to ask about them yourself, whether you are newly diagnosed, in the middle of treatment, or managing metastatic disease. Building this kind of support early, rather than waiting until a crisis, tends to make the entire experience more manageable for patients and the families supporting them.
Follow-Up Care After Treatment Ends
Follow-up care after uveal melanoma treatment is built around one central fact: this cancer can spread to the liver, sometimes many years after the primary eye tumor is successfully treated. Because of this pattern, most patients need lifelong or long-term liver surveillance, which typically includes periodic liver imaging, such as ultrasound, MRI, or CT scans, along with liver function blood tests that check for early signs of spread. How often this surveillance happens usually depends on your individual risk, which your doctor may estimate using tumor genetic testing results along with tumor size and location; ask your care team what schedule they recommend for you and why.
Alongside liver surveillance, you will also need regular eye exams to monitor the treated eye for late radiation effects like cataract, glaucoma, or radiation retinopathy, and to check your other eye as well, since your overall eye health matters for daily function regardless of which eye had cancer. Your ophthalmologist or ocular oncologist will let you know how often these exams should happen, which is often more frequent in the first few years after treatment and may space out over time if things remain stable.
Survivorship planning is a good topic to raise with your team once active treatment has settled into a follow-up routine. This includes understanding what late effects to watch for, keeping a clear written record of your treatment history (including radiation type and dose, if known), and knowing which symptoms should prompt a call to your care team right away, such as new vision changes, eye pain, abdominal pain, unexplained weight loss, or fatigue that could signal a need to check for liver involvement sooner than your next scheduled scan. For a broader look at what to expect over time, see HealthTree's guide to eye cancer survival rates.
For retinoblastoma, follow-up care centers on ongoing dilated eye exams to check both the treated eye and the other eye for new or recurrent tumors, since new tumors can sometimes develop in young children as the retina continues to grow. These exams are typically frequent in early childhood and become less frequent over time as risk decreases with age. Long-term monitoring for second cancers is also an important part of follow-up for retinoblastoma survivors, especially those with the heritable form of the disease or a history of radiation therapy, and many survivors continue some form of cancer-related monitoring into adulthood. In every case, whether you are managing your own follow-up care or your child's, do not hesitate to reach out to your care team between scheduled visits if something feels wrong; you know your body, or your child, better than anyone, and your concerns are always worth raising.
