Intraocular Tumors and Glaucoma

Updated: Jan 17, 2014
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
  • Print
Overview

Background

Intraocular tumors are rare causes of glaucoma. In cases of unexplained glaucoma, the possibility of an ocular tumor must be considered because of the dire consequences of a missed diagnosis. The epidemiology, prognosis, and mechanism of action depend on the specific tumor type. The tumor may not be directly visible in some instances, and different methods of indirect visualization may need to be used.

Next:

Pathophysiology

There are a number of different mechanisms by which ocular tumors can cause glaucoma: (1) direct invasion, (2) pigment dispersion, (3) melanophagic, (4) hemolytic, (5) uveitic, (6) secondary angle closure, (7) iris neovascularization, (8) choroidal detachment, (9) suprachoroidal hemorrhage, and (10) anterior displacement of lens-iris diaphragm.

Mechanisms of elevated intraocular pressure in intraocular malignant melanoma, which is the most common intraocular tumor causing secondary glaucoma, include the following:

Melanoma arising within the iris

  • Direct growth of the tumor into the angle
  • Tumor seeding into the angle
  • Pigment release into the anterior chamber and into the angle

Melanoma arising within the ciliary body

  • Pigment dispersion
  • Direct invasion

Melanoma arising within the choroid

  • Neovascularization of the angle
  • Anterior displacement of lens-iris diaphragm with angle closure
  • Hemorrhage with volume effect or angle closure
  • Spontaneous necrosis causing uveitis and secondary glaucoma
  • Tumor seeding into the chamber angle
  • Pigment release into the aqueous, the surface of the iris, and the chamber angle
Previous
Next:

Epidemiology

Frequency

United States

Although individual rates vary, Shields et al showed a 5% incidence of increased intraocular pressure due to intraocular tumors in a series of 2597 patients with ocular tumors. [1] This is in contrast to 50% incidence of increased intraocular pressure in eyes enucleated for tumors. Incidence of increased intraocular pressure also is dependent on location. Reports indicate a 17% incidence of glaucoma in ciliary body melanoma, 7% in iris melanoma, and 2% in choroidal melanoma. Given the relative infrequency of intraocular tumors, secondary glaucoma as a result of intraocular tumors is a rare event.

Mortality/Morbidity

Early detection of malignant melanoma of the choroid is critical because a delayed diagnosis may lead to mortality from metastatic disease.

Previous