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Surgery is used to treat some eye melanomas, but it is used much less often now because the use of radiation therapy has become more common.

Types of surgery for eye cancer

The type of surgery depends on the location and size of the tumor, how far the tumor has spread, and a person's overall health. All of these operations are done while you are under general anesthesia (in a deep sleep). Most people will stay in the hospital 1 or 2 days afterward. The operations used to treat people with eye melanoma include:

• Iridectomy: Removal of part of the iris (the colored part of the eye). This might be an option for very small iris melanomas.
• Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball. This might also be an option for small iris melanomas.
• Iridocyclectomy: Removal of a portion of the iris and the ciliary body. This operation is also used for small iris melanomas.
• Transscleral resection: Surgically removing just a melanoma of the ciliary body or choroid. This type of surgery should only be done by doctors in cancer centers with a lot of experience in treating eye melanomas, because it is hard to remove the tumor without damaging the rest of the eye. This could lead to severe vision problems.
• Enucleation: Removal of the entire eyeball. This is used for larger melanomas, but it may also be done for some smaller melanomas if vision in the eye has already been lost or if other treatment options would destroy useful vision in the eye, anyway. During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the original eye would have. Within a few weeks after surgery, you visit an ocularist (a specialist in eye prostheses) to be fitted with an artificial eye, a thin shell that fits over the orbital implant and under the eyelids. The artificial eye will match the size and color of the remaining eye. Once it is in place, it will be hard to tell it apart from the real eye.
• Orbital exenteration: Removal of the eyeball and some surrounding structures such as parts of the eyelid and muscles, nerves, and other tissues inside the eye socket. This surgery is not common, but it might sometimes be used for melanomas that have grown outside the eyeball into nearby structures. As with enucleation, an artificial eye might be placed in the socket after surgery.

Possible risks and side effects of surgery

All surgery carries some risk, including the possibility of pain, bleeding, blood clots, infections, and complications from anesthesia.

Surgery on the eye can lead to the loss of some or all of the vision in that eye. Enucleation and orbital exenteration result in complete and immediate vision loss in the eye. Other surgeries can also cause problems leading to a loss of vision, which can occur later on. In some cases, vision may have already been damaged or lost because of the cancer.

Removal of the eyeball (enucleation) obviously can affect a person’s appearance. As noted above, an artificial eye can be put in place to help minimize this.