Glaucoma, Intraocular Tumors 

  • Author: Andrew A Dahl, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 21, 2010
 

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 many instances, and different methods of indirect visualization may need to be used.

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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
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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, this condition is a rare event.

Mortality/Morbidity

Early detection of this rare tumor is important because it may increase mortality.

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Contributor Information and Disclosures
Author

Andrew A Dahl, MD  Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine

Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Shehab A Ebrahim, MD  Assistant Professor, Department of Ophthalmology, Tulane University; Vitreoretinal Surgeon, The Retina Institute, LLC

Shehab A Ebrahim, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew I Rabinowitz, MD  Consulting Staff, Department of Ophthalmology, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, and American Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Alcon Labs Salary Employment

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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