During your first visit to the ocular oncology clinic at Moorfields, we will carry out the following investigations:
Sometimes it is also necessary to perform an intravenous angiogram – this involves an injection in the arm or back of the hand of one or two dyes (fluorescein and/or indocyaninegreen). Photographs are then taken at timed intervals to look at the blood flow of the tumour. Your eye doctor will discuss the results of any investigations with you, confirm the diagnosis and discuss treatment options if you have been diagnosed with a melanoma.
It is also possible for uveal melanoma to spread to other parts of the body. The most common site of spread is to the liver. It is very unusual to find spread of cancer (metastatic disease) at diagnosis but this can happen in the future and so it is important to have regular checks of your liver after eye treatment. Your GP or medical practitioner can perform the necessary test. Metastatic melanoma is life threatening and if this should occur your treatment will be coordinated by medical oncologists. Many different treatments are available, including liver surgery, immune therapy, radiotherapy and chemotherapy.
The appropriate treatment for uveal melanoma depends largely on the size and location of the melanoma, as explained below.
Watch a video of one of our patients describing their experience of enucleation.
Welcome to this patient information video, produced by the Moorfields Eye Hospital Ocular Oncology service. It is designed for patients and carers to help them prepare for eye removal surgery, and to look after the socket, after removal.
You may feel sore and bruised and should take regular painkillers as needed. You will probably feel most sore when moving your good eye. Get plenty of rest and try to keep hydrated. Whether at home or in hospital, the following shows you what to expect the next morning.
The next morning the dressing will need to be removed, and the eye bathed. In hospital, either the surgeon or nursing team will see you and answer any questions. To clean the eye socket, you will need the following:
You should then wash your hands thoroughly with soap and water and dry them well before removing the dressings. The dressing should be removed gently by peeling the tape from the forehead to the cheek, supporting the underlying skin. It can be normal for the pad to be blood stained, or have a sticky residue, which is the antibiotic ointment applied during surgery.
The patient in this video had her surgery weeks ago, so the socket is not swollen and is well healed. Your eye socket and lid will be swollen and can look red and bruised. This can become worse over the first few days, before gradually getting better.
We will now move on to show you how to clean the eyelids after eye removal surgery.
Once the boiled water has cooled, soak the cotton pad and squeeze out the excess. Gently wipe the lids from the nose side outwards. Discard the pad after one wipe, and try to avoid scrubbing the lids or the inside of the socket. This step can be repeated until the lids are clean. You can clean the socket as often as needed to keep it comfortable.
Once the socket is clean, you can begin to use your post-operative eye drops. You apply the drops as you would in any normal eye. This slide shows you how to access a full-length instructional video showing how to apply eye drops. It is common for the eyelid to be almost closed until you receive your artificial eye. The patient in this video had her surgery weeks ago, so the socket is well healed. At the time of your operation, the surgeon will have inserted a clear plastic shell, or conformer, in the socket. You can see it in place in this patient.
This is the shell or conformer outside of the socket. Very occasionally the shell may fall out after your operation. If it does, wash it with soapy water, and rinse it thoroughly with cooled boiled water.
In this part of the video, we will demonstrate the technique to reinsert the shell.
After washing your hands and the shell thoroughly, position the shell with the more pointed end towards the nose. Stand at the side of the patient and gently lift the upper lid, whilst asking the patient to look up. Slide the shell in as high as it will go comfortably. Hold the shell in place and release the upper lid. Ask the patient to look down and gently pull down the lower lid, to allow the shell to sit back into the socket. Release and blink to check for comfort. This technique can be used when inserting the shell yourself using a mirror to help you.
If you are unable to get the shell back in without causing pain, stop, and try again the next day. There is no danger if the shell is left out for a few days. If you are still having problems please contact your local Eye Hospital for assistance.
In the weeks following your surgery, you should use your drops as prescribed, and take things easy. You can gradually return to normal activity, including washing your hair and face as normal, provided you take care not to get soap into the socket. If you experience increasing pain after the first few days, or are concerned in any way, please contact our clinical nurse specialists, or attend your local A&E in an emergency.
The final part of the recovery from having eye removal surgery, is getting your artificial eye. This will be similar to your eye, but not an exact match. This visit will also involve taking a mold of your socket, to allow your final eye to be made for you.
Here you can see an example of a shaped artificial eye in the central picture, next to a conformer on the right. This gives you an idea of what your artificial eye may look like, though it will be picked to match your original eye.
Here you can see our patient with her temporary artificial eye in place, which moves along with her good eye. Although the artificial eye does not move exactly as the original did, the range of movement is enough. Most patients find that people often have no idea they have an artificial eye, even when they come to eye clinic.
If you have any questions or concerns, you will have been given the clinical nurse specialist contact details when you were seen in the ocular oncology service.
For issues relating to your artificial eye, please contact the ocular prosthetics department directly. In an emergency, specialist eye help can be accessed via Moorfields A&E.
This video was produced by staff at Moorfields Eye Hospital, ocular oncology service.
The team would like to thank everyone who contributed to the making of this video,
and especially our patient without whom we could not have made this video at all.
A ruthenium plaque is surgically placed on the surface of your eye to treat the tumour. The plaque is a curved metal disc, about the size of a ten pence coin, which contains radioactive material, called ruthenium, which is sealed within the disc and does not contaminate the rest of your body. The tumour receives a dose of radiation whilst the plaque is on the surface of your eye, therefore you have to stay in hospital for observation (either at StBartholomew’s Hospital or Moorfields City Road).
A second operation is needed to remove the plaque before you can go home. The length of stay in hospital may vary from a few days to a week. The results can vary depending on the size of the tumour, but for small to medium sized uveal melanomas (tumours) there is a highsuccess rate. Larger tumours carry a greater risk of complications, which can damage vision.
Proton beam radiotherapy is a specialist treatment undertaken at the National Proton Beam Centre in Clatterbridge, near Liverpool. Protons are hydrogen ions that are accelerated to a high energy level, using a very strong magnet so that they are able to penetrate the eye andtarget the tumour to a specific, clearly defined depth and area. The treatment is performed over four daily outpatient visits to Clatterbridge, with accommodation provided. Before going to Clatterbridge, an eye operation is performed in London, which involves attaching small metal clips to the wall of your eye.
These clips help the specialists locate the tumour in your eye. The clips are harmless and do not need to be removed. The results of this treatment can vary depending on the size of the tumour, but for medium sized uveal melanoma there is a high success rate. Larger tumours carry a greater risk of complications, which can damage vision.
Photodynamic therapy involves the slow injection of a drug, called visudyne (verteporfin), through a vein in your arm. Once the injection has been performed, a low power laser is shone into the eye, focusing on the area being treated for just over a minute to activate the visudyne. Photodynamic therapy is reserved for only the smallest sized tumour (choroidal melanoma). The success rate is lower than conventional ruthenium plaque brachytherapy or proton beam radiotherapy. Visual complications are rare.
We usually only consider removal of the eye if:
This is only considered if a large amount of tumour has grown through the wall of the eye and cannot be removed with an enucleation.
Small melanomas near the front interior of the eye can occasionally be surgically removed under general anaesthetic. Additional ruthenium plaque brachytherapy is often recommended.
Small melanomas on the iris (the coloured part of the eye) can occasionally be surgically removed under a general anaesthetic. Additional ruthenium plaque brachytherapy is often recommended.
Stereotactic radiosurgery is a type of radiation treatment that uses gamma rays. Gamma rays are different from the x-rays used in a standard x-ray in that they have a much shorter wavelength. These gamma rays are directed at the tumour in your eye.
The treatment decision is an agreement between you and the consultant in charge, following a discussion on the advantages and disadvantages of each option above. The decision is also discussed at a multidisciplinary team meeting, when other senior members of the team and cancer specialist nurses will have an opportunity to contribute towards your treatment and care plan.
If you do require an operation this will be carried out at St Bartholomew’s Hospital or Moorfields Eye Hospital. The medical and nursing team will explain where you will receive your treatment when they discuss your treatment plan with you.
If you are finding it difficult to come to terms with your diagnosis and the treatment that you require, you may find it helpful to speak to one of our nurse counsellors based at Moorfields City Road. Counselling provides an opportunity to talk things through, allowing you the time to explore your thoughts and feelings and to make sense of the way you feel. The counsellors are based in City Road and are able to offer confidential, face-to- face counselling to all adult patients over the age of 18yrs. The service is available Monday to Friday 9-5pm.
Contact details:
You may need to leave a voicemail but please do not worry as this line is confidential. It is helpful to keep the message short and clear, including your contact details.
Your clinician can also refer you to the counselling service. If we are not able to help, we will be able to talk things through with you or point you in the direction of alternative support.
Eye clinic liaison officers (ECLOs) are available at Moorfields Eye Hospital in City Road to assist those living with sight loss. This includes patients, their relatives and carers. For more information about ECLO services at City Road, please ask a member of staff for an information leaflet, these are also available at the healthhub, located at the main entrance of the hospital.
Phone: 020 7566 2355 or email: moorfields.cityroadECLO@nhs.net
If you are feeling very distressed, despairing or suicidal and need immediate help,please contact your GP and ask for an emergency appointment. If your GP is closed, please consider calling the national non-emergency number 111.
You can also go to your nearest Accident and Emergency (A&E) department where a mental health practitioner will be able to assess you and give you appropriate help.
You can self-fund or use private medical insurance to fund your treatment.
Authors: Victoria Cohen, clinical lead consultant and Sinead Hanrahan, clinical nurse specialist
Review date: October 2023