Ophthalmic oncology is a unique field for several reasons. First, the ophthalmologist rather than the adult or pediatric oncologist is typically the coordinator of patient care, because evaluations of local control are performed with ophthalmic techniques such as indirect ophthalmoscopy under anesthesia, fundus photography, fluorescein angiography, and ocular ultrasonography.

Second, ophthalmic malignancies are also unique in that the major intraocular malignancies are routinely diagnosed and treated without pathologic confirmation. Systemic chemotherapy, ocular irradiation, and removal of one or both eyes are routinely performed without needle biopsies, incisional biopsies, or pretreatment cytologic studies. When pathologic specimens are available, they are usually interpreted by pathologists who have either trained in ophthalmology or who have had special instruction in ophthalmic anatomy. In some cases, such as the interpretation of ocular melanomas, ocular pathologists have developed their own classification schemes, cell-type terminology, and descriptions that at times are at odds with traditional oncologic pathology.

Third, the eye is a common site for metastasis, and it may be the general ophthalmologist rather than the internist who first detects that a patient has a metastatic tumor and needs to be referred to an oncologist.

This chapter reviews benign and malignant ocular, orbital, and lid tumors in both children and adults. Table 85-1 lists the most common of these tumors.