Frequently Asked Questions

Why was I sent to an oncology centre if my tumour was not malignant?

The techniques used for diagnosing and treating benign tumours of the eye are similar to those required for treating malignant tumours. The appropriate facilities are not widely available because ocular tumours are rare, making it necessary to concentrate resources in only a few centres around the country.

If I have an ocular melanoma, what are my chances of survival?

The chances of survival are usually good. They are related to:

The size of the tumour at the time of treatment;
Whether the melanoma cells are spindle-shaped or round (ie, 'epithelioid');
Whether or not certain chromosomal abnormalities are present in the tumour cells;
Whether or not certain changes have occurred in the supporting tissues within the tumour (i.e., 'closed loops').

Will my tumour grow significantly by the time I come to the oncology clinic in Liverpool?

If the tumour is a melanoma, it is most unlikely to change significantly within a few weeks, so the delay of two weeks should not alter your chances of survival or of saving your eye and vision. Nevertheless, we try to see patients quickly so as to minimize any anxiety as soon as possible. If an ocular tumour is a metastasis, arising from a primary tumour elsewhere, then rapid growth commonly occurs, making treatment more urgent.

Why didn't the doctors at my local hospital explain to me what was wrong with my eye?

Ocular tumours are rare and their treatment is highly specialized, so that some doctors prefer to leave all explanations to us.

Is the eye removed during surgery?

Not unless it is to be removed permanently. This is because it is not possible to return the eye to its normal position once it has been removed. Access to the back of the eye for the insertion of markers or a radioactive plaque or for local resection is gained by temporarily detaching one or two muscles from the eye and gently turning the eye so that it looks sideways.

How long will I be in hospital?

The time you spend in hospital will depend on the type of operation and the need for any intensive postoperative eye care. The discharge times are normally as follows:

One day after marker insertion;
One day after radioactive plaque removal;
Two days after removal of the eye;
The same day, if any procedure is performed under local anaesthesia (as after laser treatment or conjunctival biopsies (i.e., snips).

If you have plaque radiotherapy, the time for which the plaque is left in place depends on:

The size and nature of the tumour, and hence the dose required; and
The age of the plaque, which influences the amount of radiation emitted per second.

This is usually between one and seven days.

What drops will I be given on leaving the hospital and for how long?

You may be given any of the following:

Chloromycetin or other antibiotic drops, to be taken four times daily for one week, to prevent infection;
Betnesol or other steroid drops, to be taken four or six times daily for between four and twelve weeks, to reduce inflammation; and
Atropine, cyclopentolate or other pupil-dilating drops, two or three times daily for between one and four weeks, to prevent painful spasm of the eye muscles. These drops may blur your vision.

What side effects can occur with these drops?

Possible side effects include:

Allergy, characterized by itching, redness and swelling around the eye;
Blurred vision with pupil-dilating drops, because the focusing muscles are temporarily paralysed;
Glaucoma in predisposed individuals if steroid drops are administered for several weeks.
Ocular infection if long-term steroid drops suppress immunological defences.

If you develop any pain or redness after your return home, you should see your general practitioner, who would refer you to your ophthalmologist, if necessary. You can also telephone the specialist nurse or ward 8Y.

Will I be shown how to instill my eye-drops?

The ward staff will show you how to put drops in your eye. If you have any difficulties, you can try to administer the drops lying flat on your back while looking up at the ceiling and resting the drop bottle on the bridge of your nose (taking care not to contaminate the nozzle of the dropper). If you have arthritis you can ask a ward nurse to provide you with a special appliance to help you instill drops safely, but please bring this matter to the nurse's attention as soon as possible so that there is enough time for this item to be obtained.

What are the side-effects of radiation?

If you receive plaque radiotherapy or proton beam radiotherapy, any side-effects will be limited to the region of the eye itself.

Within the eye, these can include:

Fluid leakage from the tumour, this fluid accumulating within or beneath the retina, causing retinal detachment;
Closure of the blood vessels within the optic nerve or retina;
Cataract;
The formation of delicate blood vessels, which have a tendency to bleed into the eye; and
The formation of blood vessels on the iris, which prevent fluid outflow from the eye, resulting in elevation of the intraocular pressure (glaucoma).

Outside the eye, these can consist of:

Loss of lashes in the treated area;
Redness of the eye;
Watering or dryness of the eye;

Before your treatment, you will be told of the chances of developing any of these side-effects.

You should not lose your hair or develop any general side effects as a result of radiation.

Will I become radioactive when I receive plaque radiotherapy or proton beam radiotherapy?

When a radioactive plaque is in place, there may be a very small amount of radiation around you. To protect other individuals, you: (1) will not be allowed to leave the ward; (2) will need to wear an eye shield when you have any visitors; who should keep more than one metre away from you, and (3) anyone who may be pregnant or children under the age of twelve.

There is no radioactivity remaining after your treatment is completed, that is, once the radioactive plaque is removed or once the proton beam is switched off.

You may wish to purchase TV cards, telephone vouchers, and other items such as magazines before your operation. Hospital volunteers would be able to buy small items from the hospital shop and can be contacted by the ward staff.

If I have insertion of tantalum markers for proton beam radiotherapy, will these ever need to be removed?

No, unless they are placed near the front of the eye and if they cause irritation to the overlying conjunctiva, in which case they can be removed under local anaesthesia.

How much pain will I experience?

We will give you whatever medications are necessary to control pain. Our usual measures for dealing with this problem include:

Paracetamol, ibuprofen or other oral analgesics, to be taken every six hours;
Infiltration of the eye with a long-acting local anaesthetic, administered during your operation;
Strong agents, such as morphine, if pain is severe.

Previously, painkillers were only offered on request whereas now we prefer to administer these agents every six hours whether or not there is any pain, so as to prevent pain from developing in the first place. You may be asked to score the degree of pain you experience, so that we can improve our care.

If I have a melanoma, aren't my chances of survival better if my eye is removed than if it is conserved?

Several studies have shown that as long as long as the tumour is destroyed, the chances of survival are about the same whether the eye is removed or whether it is saved.

What is meant by 'conservative treatment' and is such treatment more 'old-fashioned' than radical treatment?

Conservative treatment is any kind of treatment that aims to conserve the eye and vision. Radical treatment refers to removal of the eye. Nowadays, conservative treatment has largely superseded radical treatment.

Is it possible to remove or treat the wrong eye?

To prevent the wrong eye from being treated, we always tape the normal eye shut, then sterilize the skin around the abnormal eye using a yellow disinfectant, then cover the face with a drape containing a small window, placing this window over the abnormal eye, and then we examine the eye, by ophthalmoscopy if necessary, not proceeding with the surgery until the tumour is seen. This protocol makes it impossible to operate on the wrong eye.

What should I bring with me to the hospital?

You should bring:

All your medicines and drops;
Dressing gown;
Slippers;
Underwear;
Toiletries;
Hairbrush or comb;
Toothpaste and toothbrush;
Soap and towels;
Shaving equipment

If you use any of the following:

Spectacles or contact lenses;
Hearing aid;
Walking stick;
Special shoes;
Zimmer frame

If you wish, you can bring any of the following items:

Books/magazines;
Knitting;
Writing materials;
Personal stereo;
A small amount of money;
A magnifying lens.

What should I not bring with me to the hospital?

You should not bring:

large amounts of money;
valuables;
food requiring refrigeration;
alcohol.

The hospital does not accept liability for loss of or damage to any of your personal possessions. If ambulance transport is required, only one item of luggage will be carried on the ambulance.

Will I be isolated when I am in hospital?

You will not be isolated unless (1) you are treated with you develop a severe infection (which is extremely rare).

Where can my accompanying relatives stay while I am in hospital?

If possible, your relatives will be accommodated in Royal Chambers, across the street from the hospital. If this is full, we will organize on your behalf a room at a nearby hotel.

I note that I am being seen at the Specialist Eye Research Centre (SERC). Does this mean that I am a sort of 'guinea pig'?

No. The concept of SERC is to provide special facilities so that patients can benefit from the latest developments in ophthalmology and ocular oncology, safely and efficiently. With any new treatment it is especially important to take special precautions to minimize any risks and to detect any side-effects without delay so that best possible results are achieved. Clinical research is conducted only after obtaining informed consent from the patient and the approval of the hospital's ethical committee and R & D (research and development) office.

We can remain in the forefront in our field only if we document our findings and measure our results in a scientific fashion, as recommended by national and international standards of care. This is why we ask for your written permission to use your data, surplus tissues and images for research, teaching and audit (i.e. quality control) purposes.

Can I drive a car after my treatment?

You can drive a car if you can read a numberplate from the legal distance (20.5 metres), even with one eye. You cannot drive with double vision, unless one eye is covered. If resident in the UK, you must inform your insurance and the DVLA of any severe and permanent visual loss. For further information (e.g. if you have a special licence), you can contact the DVLA by phone (0870 240 0009) or on the internet (www.DVLA.gov.uk).