Eye lymphoma

Eye lymphoma is a rare type of cancer, also known as ocular lymphoma. Lymphomas develop in the immune system, and there are two types: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Most eye lymphomas are non-Hodgkin lymphomas.

Lymphoma of the eye can be hard to diagnose and is often first treated as uveitis because it shares similar symptoms. Treatments include chemotherapy and radiotherapy and may target the eyes and the brain to try and prevent it from spreading.

Eye lymphoma can happen to anyone but is more likely in people with immune system diseases or who take medicine to suppress their immune system. If you notice any changes to your vision or the appearance of your eyes, see your optician. Opticians can refer you to specialists if they suspect eye cancer.

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Eye lymphoma symptoms

Eye cancer inside the eye can develop without causing symptoms, so it is sometimes first detected at a routine eye test. The symptoms of eye lymphoma are similar to chronic uveitis. This can delay diagnosis while people are first treated for uveitis.

Signs and symptoms of eye lymphoma can include:

  • Eye irritation and discomfort
  • Eye redness
  • Dry eyes
  • Becoming more sensitive to light
  • Blurred vision
  • Seeing floaters
  • Swelling

Eye lymphoma usually affects both eyes, though symptoms may be worse in one eye. If the cancer advances, the tumour can cause further signs and symptoms such as:

  • Double vision
  • Eye appearing larger or pushed forward
  • Loss of vision

Always see your optician if you notice vision changes or a change in the appearance of your eye. Eye cancer is rare, and symptoms will be caused by something other than cancer for most people. However, if it is cancer, the earlier it’s diagnosed, the better the prospects for treatment.

How is eye lymphoma diagnosed?

If your optician suspects you may have eye cancer, they can refer you to a specialist eye doctor called an ophthalmologist. Eye lymphoma can be hard to diagnose and may at first be treated as uveitis.

A biopsy is usually needed to confirm eye lymphoma. A biopsy is done by vitrectomy, a procedure using a very fine needle to take a tissue sample, which is later tested in a lab. You may have other tests as well. Some of these confirm the stage of your cancer to help plan treatment. Tests can include:

  • Ultrasound which uses sound waves to create images of the eye and around it.
  • Magnetic resonance imaging (MRI) scan which uses magnetism to create detailed images.
  • CT scan which uses an x-ray to produce detailed internal images of the body.

Types of eye lymphoma

There are different types of eye lymphoma, which can develop either inside or, more commonly around the eye (for example, in the eye socket or orbit). The most common type of eye lymphoma is caused by non-Hodgkin’s lymphoma.

Eye lymphoma treatment

Chemotherapy is commonly the first treatment for eye lymphoma if you are well enough to cope with it. Chemotherapy uses medicine that kills cancer cells and can be given in different ways - intravenously into the vein, intravitreal injection into the eye, and injection into the fluid around the spinal cord. Primary intraocular lymphoma is usually treated with a type of medicine called methotrexate.

Depending on your diagnosis, you may have chemotherapy followed by radiotherapy. Radiation therapy uses high energy beams to shrink tumours and kills cancerous cells. However, as radiotherapy damages healthy cells and cancer cells, there can be side effects. These can include cataracts, dry eye, neovascular glaucoma, retinopathy and optic neuritis. Your oncology team will discuss these with you before you start treatment.

What causes eye lymphoma?

Lymphomas happen when there is an abnormal growth of lymph tissues in either B cells or T cells. Anyone can develop eye lymphoma, but risk factors include:

  • Age: the incidence of ocular lymphoma increases with older age (Source: Medscape).
  • Having HIV or AIDS.
  • Epstein-Barr virus.
  • Auto-immune diseases such as rheumatoid arthritis.
  • Other conditions that affect the immune system.
  • Taking medication following organ transplant.

Eye lymphoma support

Being diagnosed with cancer is frightening and can be life-changing. You may face a long period of treatment and follow-up appointments. With eye cancer, you may also have vision changes or potentially a new visual impairment. Getting support and advice can make a big difference.

Your healthcare team will include nurses, doctors, your GP, and specialists such as your oncologist and cancer nurse. If needed, they can refer you for support from social services, local organisations, and a low vision clinic. Many people find it helps to talk to others going through similar experiences. Ask your healthcare team about local support groups.

If you experience sight loss, we are here to support you. You may need extra help managing life at home, work, and getting around. This could include making your home safer, training in skills for daily living, and guidance on getting around safely. Find out more about living with blindness or visual impairment.

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Medically reviewed by: The Royal College of Ophthalmologists on 28/07/2022

Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor

The Royal College of Ophthalmologists champions excellence in the practice of ophthalmology and is the only professional membership body for medically qualified ophthalmologists. The RCOphth is unable to offer direct advice to patients. If you’re concerned about the health of your eyes, you should seek medical advice from your GP, optometrist or ophthalmologist.

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