Eye Melanoma: Symptoms, Diagnosis, Treatment and Vision Support
Updated: 5 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
TL;DR
What it is: A cancer that begins in melanin-making cells inside the eye. It is also called ocular melanoma, intraocular melanoma or uveal melanoma, and it most often affects the uvea, which includes the iris, ciliary body and choroid.
Early signs: It may cause no symptoms at first. Possible symptoms include flashes of light, floaters, a growing dark spot in the iris, a change in pupil shape, blurry vision in one eye and loss of peripheral vision.
Diagnosis: Often starts with an eye exam and may include fundus photography, ultrasound, angiography, optical coherence tomography and tests for spread. A biopsy is not usually needed but may be used in some situations.
Treatment: Not every eye melanoma needs treatment right away. When it does, options may include radiation, laser therapy, photodynamic therapy, surgery, targeted therapy or immunotherapy.
What shapes the plan: Tumor size and location, whether the cancer has spread beyond the eye, overall health and personal preferences. Vision loss can result from the cancer or from its treatment.
When to get help: Arrange an appointment for any symptom that may relate to eye melanoma. Sudden changes in vision require emergency medical care right away.
Quick Answer: What is eye melanoma?
Eye melanoma is a type of eye cancer that starts in cells inside the eye that make melanin, the pigment that colors skin and eyes. It most often affects the uvea, the eye's middle layer, and may cause no symptoms at first. Flashes, floaters or blurry vision can occur. Treatment depends on the cancer's size, location and spread.
What the research says
Survival was similar after eye-sparing radiation and after removal of the eye in a large randomized trial. In the Collaborative Ocular Melanoma Study, 1,317 patients with choroidal melanoma were randomly assigned to iodine-125 brachytherapy or enucleation. By 12 years, all-cause mortality was 43% in the brachytherapy arm and 41% in the enucleation arm, and the investigators reported no survival difference between the treatments. Older age and larger tumor diameter were the main predictors of death (COMS Group, Arch Ophthalmol, 2006).
Tebentafusp improved survival in people whose cancer had already spread, but only in a genetically defined group. In a phase 3 trial of 378 previously untreated people with HLA-A*02:01-positive metastatic uveal melanoma, overall survival at 1 year was 73% with tebentafusp and 59% with standard therapy (hazard ratio for death 0.51, 95% CI 0.37 to 0.71). The most common treatment-related effects were rash (83%), fever (76%) and itching (69%) (Nathan et al., N Engl J Med, 2021).
Pooled data suggest the benefit is real but modest. A systematic review of six studies (631 evaluable patients with metastatic uveal melanoma treated with tebentafusp) reported a pooled median overall survival of 21.3 months and median progression-free survival of 3.6 months, with an objective response rate of 9% (95% CI 6% to 13%). These were single-arm data, so they describe outcomes rather than compare treatments (Cai et al., Front Med, 2026).
What is eye melanoma?
Eye melanoma is a type of eye cancer that starts in cells within the eye that make melanin. Melanin is the pigment that gives color to the skin, and similar pigment-making cells are found in the eyes.
The condition is also called ocular melanoma, intraocular melanoma or uveal melanoma. It most often affects the uvea, the middle layer of the eye.
Most eye melanomas develop in parts of the eye that cannot be seen by looking in a mirror. That is one reason the condition can be difficult to notice, particularly when it causes no symptoms early.
Eye melanoma at a glance
Topic | Key information |
Definition | Cancer that begins in melanin-making cells inside the eye. |
Common location | Usually the uvea: the iris, ciliary body or choroid. |
Early course | It often causes no symptoms at first. |
Possible symptoms | Flashes, floaters, a dark iris spot, pupil-shape changes, blurry vision and reduced peripheral vision. |
Diagnosis | Eye examination, imaging and tests for spread; biopsy is sometimes used. |
Treatment | May include observation, radiation, laser therapy, photodynamic therapy, surgery, targeted therapy or immunotherapy. |
Vision support | Occupational therapy and support groups may help with vision changes. |
Urgent step | Sudden changes in vision require emergency medical care. |
Where does eye melanoma develop?
The uvea has three main parts, and each can be affected:
Part of the eye | General description |
Iris | The colored part at the front of the eye. |
Choroid | A layer of blood vessels and connective tissue at the back of the uvea. |
Ciliary body | A structure behind the iris that helps the eye focus and produces aqueous humor, the clear fluid in the front of the eye. |
Eye melanoma can also occur in other areas, such as the conjunctiva, orbit or eyelid, but these forms are very rare.
What symptoms can eye melanoma cause?
Eye melanoma may not cause any symptoms. When signs do occur, they may include:
Flashes of light or floaters. These may look like specks of dust in the field of vision.
A growing dark spot in the iris. The iris is the colored part of the eye.
A change in pupil shape.
Poor or blurry vision in one eye.
Loss of peripheral vision. This means difficulty seeing objects to the side.
These symptoms can have causes other than eye melanoma. An online article cannot identify the cause of a person’s vision change.
When should you seek care?
Make an appointment with a healthcare professional if you have symptoms that may relate to eye melanoma.
Sudden changes in vision require emergency medical care right away. Do not wait for an online article to determine whether a sudden vision change is serious.
A healthcare professional can decide which examination or test is appropriate. The absence of symptoms does not establish that a person is free of eye melanoma, because the condition may be silent early.
What causes eye melanoma?
The exact cause of eye melanoma is not clear. The condition begins when cells in the eye develop changes in their DNA.
DNA carries instructions that guide cell growth, multiplication and death. In cancer cells, DNA changes can lead to rapid growth and continued survival. The extra cells may form a tumor, invade healthy tissue and spread to other parts of the body.
What are the risk factors for eye melanoma?
The following factors are associated with a higher risk:
Risk factor | What is described |
Light eye color | People with blue or green eyes have a higher risk. |
Race | White people have a greater risk than people of other races. |
Age | Risk increases with age. |
Dysplastic nevus syndrome | This inherited skin condition causes unusual moles and may raise risk. |
Ocular melanocytosis | Unusual pigmentation around the eyelids and in the uvea is linked with higher risk. |
Inherited genetic changes | Some DNA changes passed from parents to children may raise risk. |
Ultraviolet exposure | Some research suggests sunlight or tanning-bed exposure may raise risk. |
A risk factor does not mean that someone will develop eye melanoma. People without known risk factors can also develop it.
Can eye melanoma be prevented?
Healthcare professionals have not found anything that can prevent eye melanoma.
Because the condition may not cause early symptoms and may develop in parts of the eye that are not visible in a mirror, people should not rely on self-inspection alone. Professional eye care is important when symptoms or concerns arise.
Do not interpret a possible risk factor as a diagnosis. If you are concerned about your eye health, discuss the concern with an appropriate healthcare professional.
How is eye melanoma diagnosed?
Diagnosis often starts with an eye examination. Imaging tests can help show the size of a cancer.
Eye examination
A healthcare professional may first examine the outside of the eye and look for blood vessels that are larger than usual. Special equipment can then help examine the inside of the eye.
Examples include binocular indirect ophthalmoscopy, which uses lenses and a bright light, and slit-lamp biomicroscopy, which uses a microscope and an intense beam of light.
Fundus photography
Fundus photography takes color pictures of the inside surface of the eye, called the fundus. The test may help show eye melanoma and may be repeated to watch a melanoma over time.
Eye ultrasound
An eye ultrasound uses high-frequency sound waves to create pictures of the eye. A healthcare professional places a transducer on the closed eyelid or the front surface of the eye.
Angiography
Angiography creates images of blood vessels after a colored dye is injected into a vein in the arm. A camera records the dye as it travels through blood vessels in the eye.
Optical coherence tomography
Optical coherence tomography uses light waves to make images of the eye. It can show the uvea and retina, which may help reveal an eye melanoma.
Biopsy
A biopsy removes a tissue sample for laboratory testing. A biopsy typically is not necessary to diagnose eye melanoma, but it may be used in some situations or during treatment to learn more about the cancer cells.
Testing for spread
Additional tests may be needed to see whether melanoma has spread beyond the eye. These may include:
Blood tests.
Tests of how well the liver works.
Chest X-ray.
Ultrasound.
CT scan.
MRI.
PET scan.
Not every test is right for every person. The healthcare team decides which tests are appropriate based on the clinical situation.
What treatments are used for eye melanoma?
Not all eye melanomas need treatment. When treatment is needed, options may include radiation therapy, laser therapy, photodynamic therapy or surgery. Targeted therapy and immunotherapy may be used in some situations.
The best treatment depends on the size and location of the cancer, whether it has spread beyond the eye, overall health and preferences. Eye-melanoma care varies by person.
Treatment or approach | General description |
Observation | A small melanoma that is not growing may be watched for signs of growth instead of treated immediately. |
Radiation therapy | May use a temporary radioactive plaque placed on the eye or external beams such as proton beams. |
Laser therapy | Uses laser light to damage cancer cells and may include thermotherapy in some situations. |
Photodynamic therapy | Combines a photosensitizer medicine with light, usually from a laser, and may be used for smaller cancers. |
Surgery | May remove the melanoma or, for some large melanomas, the entire eye. |
Targeted therapy | May be used if the cancer has spread or surgery is not possible. |
Immunotherapy | May be used if the cancer has spread or surgery is not possible. |
When might observation be considered?
A small eye melanoma that is not growing may not need treatment right away. In that situation, a person and healthcare professional may choose to watch for signs of growth.
If the melanoma grows or causes other health concerns, treatment may be considered. Observation should be understood as a clinician-guided plan, not a decision to make from an online article.
Radiation therapy
Radiation therapy uses powerful energy to treat cancer. For eye melanoma, it may involve placing a radioactive plaque over the cancer for several days before removing it. External beams, including proton beams, may also be used over several days.
Laser and photodynamic therapy
Laser therapy uses laser light to damage cancer cells. Thermotherapy is one type and may sometimes be used with radiation.
Photodynamic therapy combines a photosensitizer medicine with light. It is used for smaller cancers in some situations.
Surgery
Surgery may remove the melanoma and a margin of healthy tissue. For some large eye melanomas, surgery may remove the entire eye, a procedure called enucleation.
After the eye is removed, an implant is often placed in the same location. After healing, an artificial eye may be made to match the other eye.
Targeted therapy and immunotherapy
Targeted therapy uses medicines that attack specific chemicals in cancer cells. It may be considered when cancer has spread beyond the eye or when surgery is not possible.
Immunotherapy helps the immune system find and attack cancer cells. It may also be considered when cancer has spread or surgery is not possible.
What complications can occur?
Eye melanoma and its treatment can lead to other health concerns:
Vision loss. Vision loss may be caused by eye melanoma or by treatment.
Spread beyond the eye. Eye melanoma can spread to areas such as the liver, lungs and bones.
The possibility and extent of complications vary. Ask the healthcare team how a proposed treatment may affect vision and daily life.
Coping with vision changes
If treatment causes total loss of vision in one eye, it may still be possible to do many familiar activities. It can take several months to adapt to a different way of seeing.
Having vision in only one eye can affect depth judgment and awareness of what is happening on the side where vision was lost. An occupational therapist can help with adaptation, and a support group may also be useful.
How can you prepare for an appointment?
Start with a primary healthcare professional if you have symptoms that worry you. If an eye problem is suspected, you may be referred to an ophthalmologist. A person with eye melanoma may be referred to an ocular oncologist, a doctor who specializes in eye cancer.
Before the appointment, write down:
Your symptoms and when they began.
Whether symptoms are continuous or come and go.
Any family medical history that may be relevant.
All medicines, vitamins and supplements you take.
Major recent stresses or life changes.
Questions about diagnosis, treatment, side effects and vision.
Useful questions may include:
Where is the eye melanoma located?
What is its size?
Has it spread beyond the eye?
Will more tests be needed?
What treatment options are available?
How might treatment affect vision and daily life?
Do I need to see other specialists?
Do I have to have treatment immediately?
Frequently asked questions
What is eye melanoma?
Eye melanoma is a cancer that starts in melanin-making cells inside the eye. It most often affects the uvea and may also be called ocular, intraocular or uveal melanoma.
What are the symptoms of eye melanoma?
Possible symptoms include flashes or floaters, a growing dark spot in the iris, a change in pupil shape, blurry vision in one eye and loss of peripheral vision. Eye melanoma may cause no symptoms at first.
Can eye melanoma have no symptoms?
Yes. Most eye melanomas form in parts of the eye that cannot be seen in a mirror, and the condition typically may not cause symptoms early. This is why symptoms alone cannot rule it in or out.
Are floaters a sign of eye melanoma?
Flashes or floaters can be symptoms of eye melanoma, but they can also have other causes. New or concerning visual symptoms should be assessed by a healthcare professional, and sudden vision changes require emergency care.
How is eye melanoma diagnosed?
Diagnosis often starts with an eye exam. Tests may include fundus photography, ultrasound, angiography, optical coherence tomography and, in some situations, biopsy or tests for spread.
Does every eye melanoma need treatment right away?
No. A small melanoma that is not growing may be watched for signs of growth. This is a healthcare-guided decision based on the person’s situation, not a general recommendation for everyone.
What treatments are used for eye melanoma?
Treatment may include radiation, laser therapy, photodynamic therapy or surgery. Targeted therapy and immunotherapy may be used in some situations, and the choice depends on cancer size, location, spread, overall health and preferences.
Can eye melanoma cause vision loss?
Yes. Vision loss may occur because of the melanoma or its treatment. Support from an occupational therapist may help a person adapt to changes in vision.
Can eye melanoma spread beyond the eye?
Yes. Eye melanoma can spread beyond the eye, including to the liver, lungs and bones. Tests may be used to look for spread.
When should sudden vision changes be treated as an emergency?
Sudden changes in vision require emergency medical care right away. Do not delay urgent assessment while trying to identify the cause online.
Conclusion: what to remember about eye melanoma
Eye melanoma is a serious eye cancer that often begins in the uvea and may not cause early symptoms. Flashes, floaters, a growing dark iris spot, pupil changes, blurry vision or loss of peripheral vision should be assessed by a healthcare professional.
Diagnosis may use an eye examination, imaging and tests for spread. Not every melanoma needs immediate treatment, and available options may include observation, radiation, laser therapy, photodynamic therapy, surgery, targeted therapy or immunotherapy. The plan depends on the cancer’s size and location, whether it has spread, overall health and preferences. If you notice sudden changes in vision, seek emergency medical care right away rather than relying on an online article.
References
Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol. 2006;124(12):1684-1693. PMID: 17159027. DOI: 10.1001/archopht.124.12.1684
Nathan P, Hassel JC, Rutkowski P, et al. Overall survival benefit with tebentafusp in metastatic uveal melanoma. N Engl J Med. 2021;385(13):1196-1206. PMID: 34551229. DOI: 10.1056/NEJMoa2103485
Cai H, Huang Z, Wang BL, et al. Clinical outcomes of tebentafusp in metastatic uveal melanoma: a systematic review and single-arm meta-analysis. Front Med (Lausanne). 2026;13:1826626. PMID: 42388498. DOI: 10.3389/fmed.2026.1826626
Mayo Clinic Staff. Eye melanoma: Symptoms and causes (patient information page; August 3, 2026). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/eye-melanoma/symptoms-causes/syc-20372371
Mayo Clinic Staff. Eye melanoma: Diagnosis and treatment (patient information page; August 3, 2026). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/eye-melanoma/diagnosis-treatment/drc-20372376
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.
It does not diagnose eye melanoma, interpret a person’s symptoms or recommend an individual treatment plan. Sudden changes in vision need emergency medical care.
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