Dr. Ganesh Pillay, Chief of Research & Academics and Regional COO (Central India), ASG Eye Hospital
India carries one of the world’s largest burdens of eye cancer, yet public conversation almost entirely focuses on childhood tumours. Adults and particularly older adults are rarely mentioned. This silence has consequences. By the time many of my senior patients reach the ophthalmologists, their tumour has grown significantly larger than it needed to be, and treatment options are correspondingly more limited.
What are the eye cancers that seniors actually face?
What the LVPEI data reveals is something clinicians across India are increasingly seeing in their own practice. This is not an isolated spike, but part of a broader shift in how ocular cancers are presenting. Large EMR-based analyses of over 9,600 cases show that nearly a third of eye tumours are already malignant by the time patients seek care, with ocular surface squamous neoplasia (OSSN) and sebaceous gland carcinoma consistently leading the mix in adults. The age pattern is particularly telling—OSSN begins to dominate from early adulthood and becomes even more pronounced in older patients, pointing to the long-term effects of UV exposure combined with delays in diagnosis. The story is similar in eyelid cancers, where sebaceous gland carcinoma makes up a significant share—often between 28% and 40% in Asian populations—and is known for its aggressive progression, especially when detected late. Globally too, OSSN accounts for a meaningful proportion of ocular tumours, with higher incidence in tropical regions and a clear bias toward older age groups. Put together, this is less about isolated data points and more about a pattern that is becoming difficult to ignore: as India’s population ages, ocular cancers are not just becoming more common, but are increasingly defined by a small group of aggressive tumours that demand far earlier diagnosis and more focused clinical pathways.
Sebaceous gland carcinoma deserves particular attention because it is genuinely a disease of ageing the mean age at diagnosis ranges between 57 and 75 years, and it predominantly affects older women. In India, it accounts for 53% of all malignant eyelid tumours, a strikingly higher proportion than in Western countries. The reason so many patients are diagnosed late is equally striking: the tumour is a master of disguise. It routinely masquerades as a harmless chalazion (a common eyelid cyst) or chronic eye inflammation. Studies report that misdiagnosis, both clinical and pathological, occurs in up to 40–75% of cases when interpreted by clinicians unfamiliar with this cancer. A case study of a patient showed, a 71-year-old retired schoolteacher, had been treated for a ‘persistent stye’ for over a year before a biopsy finally confirmed the truth.
Why do older patients get treated late?
Usually, three patterns repeat themselves. First, seniors tend to attribute vision changes and eye discomfort to ‘old age’ or existing conditions like cataracts or diabetes. A subtle growth on the eyelid rarely triggers alarm. Second, awareness campaigns, whether by hospitals, government bodies, or the media, their focus is overwhelmingly on retinoblastoma in children. Adults have no equivalent framework to recognise warning signs. Third, access remains a big barrier. A 2024 multi-centre study across North and Central India noted that orbital and intraocular tumours presented more widely dispersed across geography, indicating that patients travel significant distances to reach specialist care and many never make that journey at all.
The situation is compounded by a structural gap in India, which still has no national ocular oncology registry. The result is that it is difficult to precisely point out how many seniors develop eye cancer each year, because the data simply does not exist. As the Indian Journal of Ophthalmology noted in 2024, the exact incidence of ocular tumours in India remains unknown. Without numbers, there is no urgency and without urgency, there is no policy.
What should you watch for?
Each person over sixty to know these warning signs, a persistent lump or thickening on the eyelid that does not resolve with treatment, a reddish or whitish growth on the white of the eye that gradually enlarges, unexplained loss of eyelashes from one part of the lid, sudden blurring or floating shapes in one eye that are not explained by your existing eye condition, or a ‘chalazion’ that keeps recurring in the same spot. Notable thing is that none of these are certain signs of cancer, but each deserves a thorough evaluation at a centre with ocular oncology expertise, not just a general eye clinic.
The good news is that many of these cancers, when caught early, can be treated effectively with eye-preserving surgery, with or without radiation. The outcomes data from Indian institutions are genuinely encouraging for early-stage disease. But early detection requires early presentation and that begins with awareness.
India’s senior population is projected to exceed 340 million by 2050. If we do not build ocular oncology awareness that speaks directly to older adults in their language, about their cancers then we will continue to diagnose too late, treat too little and lose too many. Seniors are not a footnote in eye cancer. They are the majority. It is the time they are treated as such.