1. Eyelid Tumors

• Benign tumors: Papilloma, seborrheic keratosis, nevus.
• Malignant tumors: Basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma.

2. Conjunctival Tumors

• Benign tumors: Nevus, epibulbar dermoid.
• Malignant tumors: Conjunctival melanoma, squamous cell carcinoma.

3. Intraocular Tumors

• Benign tumors: Choroidal hemangioma, retinal astrocytoma.
• Malignant tumors: Retinoblastoma, uveal melanoma.

4. Orbital and Optic Nerve Tumors

• Benign tumors: Cavernous hemangioma, pleomorphic adenoma.
• Malignant tumors: Rhabdomyosarcoma, optic nerve glioma, metastatic tumors.

• Clinical Examination: Slit-lamp biomicroscopy, fundoscopic examination.
• Imaging Techniques: Ultrasound, CT, MRI, fluorescein angiography.
• Biopsy and Histopathology: Essential for definitive diagnosis in suspicious lesions.
• Genetic Testing: Useful in hereditary conditions like retinoblastoma.

1. Eyelid Tumors

• Benign tumors: Simple excision, cryotherapy, or laser ablation if symptomatic.
• Malignant tumors:
  • Surgical excision with wide margins to ensure complete removal.
  • Mohs micrographic surgery for basal and squamous cell carcinoma to minimize recurrence risk while preserving healthy tissue.
  • Reconstructive surgery may be necessary for restoring eyelid function and aesthetics post-tumor removal.
  • Radiotherapy can be an adjunct treatment for cases where surgical excision is incomplete or recurrence risk is high.
  • Systemic chemotherapy or immunotherapy for aggressive cases, particularly sebaceous gland carcinoma, which can metastasize.

2. Conjunctival Tumors

• Benign tumors: Close observation with periodic eye exams; surgical excision when lesions cause irritation or vision obstruction.
• Malignant tumors:
  • Wide surgical excision with cryotherapy to destroy any residual malignant cells and prevent recurrence.
  • Topical chemotherapy (mitomycin C, 5-fluorouracil, interferon-alpha) used as adjunctive therapy to treat carcinoma in situ or as a primary treatment for non-invasive lesions.
  • Radiotherapy or brachytherapy for more invasive or recurrent tumors, aiming to preserve the eye while controlling the tumor growth.
  • Systemic chemotherapy or targeted therapy in advanced conjunctival melanoma to address metastatic spread.

3. Intraocular Tumors

• Benign tumors: Typically monitored through periodic imaging and clinical evaluation; intervention only if growth affects vision or causes complications.
• Malignant tumors:
  • Retinoblastoma:
    • Systemic chemotherapy (vincristine, carboplatin, etoposide) used in cases of bilateral retinoblastoma or large tumors requiring volume reduction before local treatment.
    • Intra-arterial chemotherapy (melphalan) delivered directly into the ophthalmic artery, minimizing systemic toxicity while effectively targeting tumor cells.
    • Laser photocoagulation or cryotherapy used for small, localized tumors to destroy tumor cells with minimal side effects.
    • Enucleation (complete removal of the eye) is considered in advanced or refractory cases where vision cannot be preserved.
    • Proton beam radiotherapy can be used for cases requiring radiation while minimizing collateral damage to surrounding tissues.
  • Uveal melanoma:
    • Plaque brachytherapy (radioactive plaques placed near the tumor) is the most commonly used eye-sparing treatment for small to medium-sized melanomas.
    • External beam radiation therapy employed in larger tumors or cases where plaque brachytherapy is not feasible.
    • Enucleation performed when tumors are large, vision is lost, or there is extraocular spread.
    • Systemic targeted therapy (BRAF/MEK inhibitors) used in metastatic melanoma cases to slow progression.
    • Immunotherapy (checkpoint inhibitors like pembrolizumab) for late-stage melanoma cases with systemic involvement.

4. Orbital and Optic Nerve Tumors

• Benign tumors: Observation with regular imaging is recommended for slow-growing lesions; surgical excision performed in symptomatic cases or when growth is suspected.
• Malignant tumors:
  • Rhabdomyosarcoma:
    • Multimodal therapy, including systemic chemotherapy (vincristine, dactinomycin, cyclophosphamide), is the primary treatment to shrink the tumor before surgery.
    • Radiotherapy is frequently combined with chemotherapy to ensure complete tumor eradication.
    • Surgical resection performed selectively in cases where complete removal does not compromise vital ocular structures.
  • Optic nerve glioma:
    • Observation is recommended for small, asymptomatic tumors, especially in pediatric patients with neurofibromatosis type 1.
    • Chemotherapy (carboplatin, vincristine) is the primary treatment for progressive tumors causing vision loss.
    • Radiotherapy is reserved for older children and adults where chemotherapy fails to control tumor progression.
  • Metastatic tumors:
    • Systemic chemotherapy and radiation therapy are the mainstay of treatment to manage the primary malignancy and limit further ocular spread.
    • Palliative surgical debulking may be considered to alleviate symptoms such as proptosis and pain.
  • Orbital exenteration (removal of the eye and surrounding tissues) is a last-resort procedure for extensive tumors that are non-responsive to other treatments.