Oculoplasty And Ocular Oncology

Cancers of the eye and the surrounding structures (Ocular Oncology) can affect all age groups, starting from young children to elderly individual. The treatment of the eye cancer requires a specialized team of doctors, nurses, low vision and rehabilitation facilities as well facilities for ocular pathology services, genetic counselling and prosthetic rehabilitation. The Integrated Eye Cancer Treatment centre at Dr Shroff’s Charity Eye Hospital is the first of its kind in North India with dedicated facilities for treatment of various eye cancers under one roof.  In tune with the hospital’s mission and vision of providing quality care to patients from all sections of the society, the centre has tied up with likeminded NGOs and philanthropists to provide highly subsidized treatment to the patients from underprivileged section of the society. The centre currently treats about 400 patients with various eye cancers annually referred from across the country as well as identified through the primary and secondary care network of the hospital.

What are the signs of eye cancer? When should one suspect

  • Bulging or outward protrusion of one eye
  • A pigmented patch which is growing in size
  • A lump or mass on the lids which has started increasing in size
  • Blurring of vision, shadows or flashes, wavy lines in the vision
  • Loss of vision ( partial or total)
  • Localized congestion or redness in the eyes

The various types of eye cancers treated at the centre include:

  1. Retinoblastoma: Retinoblastoma is the most common intraocular malignant tumor in children. This tumor is most commonly seen in children less than 5 years of age where it is seen as a white reflex (also called cats eye reflex) either involving one or both eyes. These tumor develop from retina and either grows inside the eye (endophytic) or grows outside the eye (exophytic). While timely detection and prompt treatment can save not only the eye and vision, delayed diagnosis and treatment can make this cancer spread to the brain and other parts of the body and can be fatal. Retinoblastoma can be treated by various modalities like intravenous chemotherapy, laser and cryotherapy, enucleation surgery, radiotherapy and the newer treatment modalities like intravitreal chemotherapy and intra-arterial chemotherapy(IAC).
  2. Melanoma: Melanoma arise from pigmented cells of the eye called melanocytes and can arise from either iris (coloured part of the eye), choroid (pigmented nourishing layer of eye that nourishes retina) or ciliary body (contains muscles which help in changing focus of lens for distance and near object). It can also involve conjunctive where it is seen as a dark pigmented patch over the surface of eye. Melanoma are usually aggressive malignant tumors, usually affecting the elderly and if not detected and treated on time can spread to the other parts of the body and can be fatal. Melanoma can be detected by a detailed examination of the eye by an eye surgeon with special training in diagnosis and treatment of eye cancer (ocular oncologist).
  3. Lymphoma: Lymphoma is another malignant tumor which can involve the eye. Most commonly it’s the Non Hogdkins lymphoma originating from white blood cells of lymphatic system which involves the eyeball. They can develop from retina (light sensitive tissue of eye), vitreous (jelly like fluid inside the eye) or from optic nerve at the back of the eye.
  4. Eyelid tumor : There are various forms of the cancers seen involving eyelid like sebaceous gland carcinoma, squamous cell carcinoma or basal cell carcinoma which presents as a mass in the eyelid and progressive increase in size. Complete removal by surgery under frozen section margin control is the commonest treatment modality of choice.
  5. Orbital tumor: Orbital tumors can be benign or malignant, or they can be primary or metastatic. The most common benign tumor involving orbit is cavernous hemangioma affecting young or middle aged adults. Other types of orbital tumors are  meningiomas, schwannomas, lacrimal gland tumors ,optic gliomas or sarcomas. Orbital tumors present as progressive bulging and/or displacement of the eyeball with or without a palpable or visible lump around the eyeball. Most orbital tumors are treated by surgical removal and additional treatment like chemotherapy and radiotherapy might be required in selected aggressive malignant tumors.
  6. Conjunctival carcinoma: Carcinoma of the conjunctiva and cornea (visible outer layer of the eyeball) also know as OSSN  (ocular surface squamous neoplasia) is a common tumor of the eye. This tumor is usually visible as a reddish/pinkish lump. Treatment is usually by a simple surgery or with topical chemotherapy medications
  7. Secondary tumors(metastasis): These are malignant tumor cells from other parts of the body which involves eye, Most commonly they involve choroidal layer of the eye since it is the most vascular structure of the eye. The common eye metastasis is from breast cancer (in females) and lung cancer (in males).

Eye cancer treatment facilities at Dr. Shroff’s Charity Eye Hospital:

The Integrated Eye Cancer Treatment Centre at Dr Shroff’s Charity Eye Hospital treats more than 400 patients with eye tumour every year and has the following facilities for treatment:

  1. Trained Ocular Oncologist
  2. Paediatric Oncologist
  3. Radiation Oncologist(In collaboration)
  4. Trained Oculoplasty surgeons
  5. Ocular Onco-pathology Services in house
  6. In house chemotherapy facilities
  7. Plaque brachytherapy facility in house
  8. Paediatric anaesthesia services and facilities for same day paediatric examination under anaesthesia (EUA)
  9. Trained oncology nurses
  10. Investigation modalities for diagnosis and monitoring of eye cancers like
    1. Ultrasound B scan
    2. Ultrasound bio microscopy
    3. Anterior segment and Retinal OCT
    4. Fluorescein angiography and OCT angiography
    5. Imaging modalities like CT/MRI (in collaboration) etc.
    6. Trans pupillary thermotherapy (TTT) and laser therapy facilities
  11. Cryotherapy facilities
  12. Facilities for specialized ocular surgeries like paediatric retinal, cataract, glaucoma and corneal surgeries
  13. Intravitreal chemotherapy facilities
  14. Intra-arterial chemotherapy for retinoblastoma (In Collaboration)
  15. In house genetic counsellor and genetic testing for ocular tumours
  16. Customized ocular prosthesis services in house for prosthetic rehabilitation after treatment of eye tumors
  17. Low vision and rehabilitation services

 

Our team:

  1. Dr Sima Das (Ocular Oncologist)
  2. Dr Amita Mahajan (Pediatric Oncologist)
  3. Dr Manu Bhaduria (Radiation Oncologist)
  4. Dr Ramesh Desai (Medical physicist)
  5. Dr Sweety Tiple (Oculoplasty surgeon)
  6. Dr Arpan Gandhi (Ocular Pathologist)
  7. Ms Riya Rati (Genetic counsellor)
  8. Ms Jijimol (Ocularist)