Overlooked Danger: India records one of highest eye cancer rates, especially among children

Hyderabad: India has among the highest rates of eye cancer worldwide, especially in children. Eye cancers, though rare, are a serious threat to the affected individuals.

Eye cancers overlooked

Cancers are usually associated with lungs, breast or skin, but ocular (eye) cancers are overlooked despite potentially devastating consequences.

Eye cancer can lead to permanent vision loss or require eye removal (enucleation) if not detected early. Limited awareness results in delayed diagnoses when treatment options become restricted and result in poor outcomes.

Around 1,000 out of every 5,000 eye cancer cases are occurring in India, even though eye tumours account for less than 0.5 per cent of the total cancer occurrences.

High case burden in India

Retinoblastoma, a potentially fatal eye cancer affecting young children, is more common in India than in most other countries. The Asia-Pacific region reports the highest global incidence of retinoblastoma, with India accounting for the largest number of documented cases.

Dr Swathi Kalki, head of Orbit and Ocular Oncology, LV Prasad Eye Institute, Hyderabad, said, “Among adults, ocular surface squamous neoplasia (OSSN) and sebaceous gland carcinoma represent the most prevalent eye cancers in India.”

OSSN remains the primary conjunctival malignancy, while sebaceous gland carcinoma dominates eyelid cancer cases at 53 per cent of all eyelid malignancies—significantly higher than rates observed in Western countries.

“Conversely, uveal melanoma, common in Western populations, remains relatively uncommon in India,” Dr Swathi said.

How does cancer form?

Cancer occurs when cells begin to divide and multiply out of control, leading to the formation of a mass called a tumour. Some pieces of the tumour can break off and spread to lymph nodes and the bloodstream, and the cancer cells can even travel to other parts of the body through the bloodstream and lymphatic system, causing new tumours to form in other organs.

Understanding eye cancer risk factors

The development of eye cancer varies by tumour type and is influenced by genetic and hereditary predispositions, racial and ethnic background, ultraviolet light exposure, compromised immune function, lifestyle factors including tobacco use, light-coloured irises, advanced age and pre-existing ocular conditions.

Recognising eye cancer warning signs

Dr Swathi emphasised the need for early detection of eye cancer, which is challenging as symptoms may be subtle or absent. “Often, these malignancies are discovered during routine eye examinations, highlighting the importance of regular checkups,” she said.

The important warning signs include white pupillary reflex in children, vision deterioration or sudden loss, dark or expanding lesions on the eye surface, unilateral eye protrusion or appearance changes, eyelid or periocular masses, visual phenomena such as flashes, floaters, or distortions, persistent eye redness, irritation, or inflammation and ocular or periocular pain.

Treatment Protocols: Conserving vision, eye integrity and life

The tumour’s characteristics, location, size, growth patterns and complications determine the treatment strategies.

Dr Swathi said, “Some of the strategies include monitoring slow-growing or small benign tumours, tumour removal with maximum preservation of eye function, chemotherapy which can be administered topically, intravenously, intra-arterially or intravitreously based on cancer type and location”.

Radiation therapy, utilising ophthalmic plaque radiotherapy or external beam radiation and enucleation or exenteration for eye removal, are considered only when vision-sparing treatments are not viable and there are other available treatment options.

However, despite the advances in cancer treatment resulting in higher survival rates and enhanced eye and vision preservation potential, early intervention remains critical for optimal outcomes.

Eye cancer challenges in India

The lack of awareness and limited access to trained professionals in this field remain a significant concern in addressing the eye cancer problem in India.

“Protective measures and early intervention are highly essential to prevent and treat eye cancers. Promptly investigating unusual eye symptoms, including vision changes, swelling or appearance abnormalities, maintaining regular comprehensive eye examinations even in the absence of symptoms and seeking specialized evaluation for persistent eye conditions are important,” Dr Swathi said.