Glaucoma, Intraocular Tumors Treatment & Management

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

Medical Care

  • Glaucoma management itself begins with medical therapy, concurrent with treatment of the intraocular tumor through surgery, radiation, chemotherapy, or a combination of these treatments.
  • Standard methods of intraocular pressure control should be used, although success rates with these topical medications will necessarily be low.
  • Anti-vascular endothelial growth factor (anti-VEGF) therapy may be helpful in those cases where neovascularization plays a role in the pathogenesis of the glaucoma.
  • In systemic lymphoma, leukemia, and metastatic malignancies, treatment will often include systemic chemotherapy and radiation, with current regimens favoring the use of chemotherapy first.
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Surgical Care

  • Surgical options to control intraocular pressure must be tempered by the need for preventing extraocular tumor spread.
    • For smaller tumors, observation is warranted until growth is documented.
    • Iridectomy or iridocyclectomy also are options for removing smaller tumors.
    • For anterior tumors, argon laser trabeculopexy to tumor-free areas is an option.
    • More posterior tumors may require local resection, photocoagulation, or episcleral radiopaque therapy. Enucleation or exenteration also is an option.
  • For melanocytoma, laser or surgical excision of the lesion may decrease the pigment load and decrease the intraocular pressure.
  • Glaucoma usually is associated with advanced stages of retinoblastoma, and enucleation may need to be discussed. Other therapeutic options include radiotherapy, cryotherapy, and photocoagulation. Any intervention must be tempered by the risk of extraocular spread.
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Consultations

Glaucoma specialist or oncologist

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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.

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