Eye brachytherapy is a localized radiation treatment for eye cancer, such as uveal melanoma, involving the placement of a small, radioactive plaque on the eye over the tumor. This plaque, often gold with radioactive seeds, delivers radiation continuously to destroy cancer cells, shielding healthy tissues. The aim is to eliminate cancerous cells while preserving the eye and, ideally, vision.
Immediate Post-Procedure Experience
After the brachytherapy plaque is placed, you will remain in the hospital. The plaque is left for a few days, often between two to seven days, depending on the tumor’s characteristics and the prescribed radiation dose. Mild discomfort, such as a scratchy sensation or feeling like something is in your eye, can be managed with medication.
While the plaque is in place, your eye will be covered with a bandage or eye patch, sometimes with a lead shield for radiation safety. Temporary vision changes, such as blurriness or double vision, are common during this period. You will be under radiation precautions, which involve limiting close physical contact with others, especially children and pregnant individuals. The plaque is removed during a second surgical procedure, after which you can return home the same day.
Managing Recovery and Common Symptoms
Once the plaque has been removed, your eye will begin to heal, and you will no longer need to follow radiation precautions. Common symptoms in the weeks following the procedure include redness, swelling, irritation, a feeling like sand is in your eye due to stitches, light sensitivity, and mild pain or soreness.
To manage these symptoms, your medical team will prescribe eye drops, which may include antibiotics to prevent infection and anti-inflammatory medications. Oral pain relievers can help with any discomfort. Maintaining good hygiene is important; gently clean around the eye with a warm, clean washcloth, avoiding any scrubbing or rubbing. Activity restrictions are advised for several weeks, such as avoiding strenuous exercise, heavy lifting, swimming, or getting soap directly into the eye. It is important to follow all post-operative instructions from your care team to support proper healing.
Long-Term Vision and Potential Side Effects
Vision changes are a long-term consideration after eye brachytherapy, depending on the tumor’s size, location, and the radiation dose delivered. While the goal is to preserve vision, blurriness or a decline in vision in the treated eye is common. Changes can appear months or even years after treatment, with vision loss in the treated area noticeable within 12 to 18 months. The extent of vision changes depends on whether the tumor was close to the central vision area or optic nerve.
Other potential long-term side effects include radiation-induced cataracts, which involve cloudiness in the eye’s lens and are a common reason for vision issues after treatment. These can develop within months to years, with a median time of 2.5 years post-treatment. Glaucoma, characterized by increased eye pressure that can damage the optic nerve, is another possible complication, sometimes occurring years after treatment. Radiation retinopathy, a condition where radiation damages the blood vessels in the retina, can also develop, potentially leading to further vision impairment.
These potential complications are closely monitored by your medical team during follow-up appointments. You should seek immediate medical attention if you experience sudden vision loss, severe pain not relieved by medication, excessive discharge, or signs of infection such as increased swelling, heat, or redness around the eye.
Ongoing Care and Monitoring
Regular follow-up appointments are a key part of post-brachytherapy care to monitor the eye’s health and the tumor’s response. These appointments begin a few weeks after the plaque removal and continue for many years. During these visits, your ophthalmologist will conduct comprehensive eye exams to assess your vision, check for any developing side effects, and monitor the treated area.
Imaging scans, such as ultrasounds, may also be performed periodically to track the tumor’s size and ensure it is shrinking or remaining stable. This long-term monitoring is important for detecting any tumor recurrence or managing late-onset side effects like cataracts, glaucoma, or radiation retinopathy. Adhering to the scheduled follow-up visits allows your medical team to intervene promptly if any issues arise, aiming to preserve as much vision and eye health as possible.