Glaucoma secondary to Intraocular Tumors

Ocular tumors, such as choroidal melanoma, retinoblastoma, and choroidal metastases can cause glaucoma by several mechanisms. These tumors can block the drainage angle of the eye, limiting the drainage of the aqueous humor (fluid found in the anterior chamber of the eye) resulting in increased intraocular pressure. In addition, tumor-related inflammation, neovascularization, or direct infiltration of cancer cells into the trabecular meshwork (the draining angle of the eye) may further contribute to the development of glaucoma.

The diagnosis of glaucoma due to eye tumors requires a comprehensive eye evaluation. This usually includes a thorough examination of the anterior and the posterior chamber of the eye, tonometry to measure intraocular pressure, optic nerve evaluation, visual field testing, and imaging studies such as ultrasound or optical coherence tomography (OCT). Detection and follow-up of eye tumors may involve specialized imaging techniques, such as fundus photography, fluorescein angiography, or ultrasound, depending on the type of tumor suspected.

Treatment of glaucoma due to ocular tumors requires a multidisciplinary approach involving ophthalmologists specializing in ocular oncology and ophthalmologists specializing in glaucoma. The primary goals of treatment are to reduce pressure, preserve visual function, and control the underlying tumor. The choice of treatment modalities depends on factors such as tumor characteristics, the extent of glaucoma, and the patient’s general health.

In many cases, a combination of medical and surgical interventions is necessary to manage both the tumor and the glaucoma. Medical treatment may include the use of topical or systemic medications to lower intraocular pressure, such as beta-blockers, prostaglandin analogs, carbonic anhydrase inhibitors, or alpha-adrenergic agonists. These drugs aim to enhance the drainage of aqueous humor or reduce its production. However, response to medical therapy may be limited, particularly if the tumor obstructs normal drainage pathways.

Prior to surgical treatment of glaucoma, effective tumor control with treatments such as radiation therapy, laser therapy, or surgical excision is required. The choice of tumor-specific therapy depends on factors such as tumor size, location, and histopathology, as well as the patient’s overall health status.

Surgical options for glaucoma secondary to ocular tumors usually include implantation of an aqueous humor drainage device (see link) or cyclodiode of the ciliary body (see link).

Dr Gkaragkani had the opportunity to specialize at the Lausanne University Hospital Jules Gonin under the supervision of the world known Greek professor and specialist in Ophthalmic Oncology, Mr. Leonidas Zografos. During her training she dealt with the treatment and follow-up of complex oncological cases. In addition, as Deputy Director of the Glaucoma Department at the Jules Gonin Ophthalmic Hospital in Lausanne, she manages a large number of glaucoma cases due to intraocular tumors having performed a large number of aqueous drainage device implantation procedures in patients with particularly satisfactory results.