Ocular Melanoma Misdiagnosis Claims in Ireland: Late Diagnosis of Eye (Uveal) Cancer
In short: A delayed or missed ocular melanoma diagnosis can be the basis of a personal injury claim in Ireland. A claim arises where an optometrist, GP or hospital failed to act on a suspicious eye finding or on warning symptoms, and that failure caused avoidable harm. Ocular melanoma is a cancer that grows inside the eye, not a skin melanoma and not a problem with eye surgery.
Because eye melanoma can spread, a delay that lets the tumour grow can reduce treatment options and survival, which is what the claim seeks to compensate. You generally have two years less one day from your date of knowledge to start a claim.
- National service
- Ocular oncology is centralised to one national centre, the Royal Victoria Eye and Ear Hospital in Dublin, since 2010.
- How common
- About 9.5 cases per million people each year in Ireland.
- Who regulates opticians
- The Optical Registration Board at CORU, under the Health and Social Care Professionals Act 2005.
- Legal standard
- The Dunne test: the standard of a competent practitioner of similar skill.
- Time limit
- Two years less one day from your date of knowledge. For a child, time starts at age 18.
- Court route
- The High Court Clinical Negligence List, not the Injuries Resolution Board (IRB).
Contents
What ocular melanoma is, and how it differs from skin cancer
Ocular melanoma is a cancer that forms inside the eye. According to the Irish Cancer Society, melanoma can develop in the eye as well as the skin[15]. Most cases are uveal melanoma, which arises in the pigmented middle layer of the eye made up of the choroid, ciliary body and iris. Roughly four in five Irish cases are choroidal, meaning the tumour sits at the back of the eye. This is a separate disease from cutaneous melanoma, which forms in the skin. If your concern is a missed skin lesion, our page on melanoma and skin cancer misdiagnosis covers that pathway instead.
Where ocular melanoma forms in the eye
The diagnostic challenge sits in one place. A common, harmless freckle inside the eye, called a choroidal naevus, can look similar to an early melanoma. A naevus is found often on routine examination and is usually watched. A melanoma is rare but dangerous. The clinical task is to tell the two apart and to act when a lesion shows suspicious features.
Naevus or melanoma: features a clinician weighs
Usually a benign naevus
Flat or only slightly raised, stable over time, with no fluid under the retina and no related visual symptoms.
Features that raise concern
Thickness beyond about two millimetres, fluid under the retina, or related visual symptoms. Other concerning signs are orange pigment over the lesion, a margin close to the optic disc, or growth over time.
A claim does not arise because the cancer is hard to see. It can arise where a competent practitioner would have recognised the risk and referred or reviewed the patient, and did not.
How ocular melanoma is diagnosed and treated in Ireland
Ireland runs a single national service for this cancer. Since 2010, ocular oncology has been centralised to one national centre in Dublin, the Royal Victoria Eye and Ear Hospital. This is set out in peer-reviewed research on uveal melanoma in Ireland Uveal Melanoma in Ireland (2019)[1]. That study put the age-adjusted incidence at about 9.5 per million people each year. A later series recorded around 46 to 51 patients treated annually in 2019 and 2020 Irish Journal of Medical Science (2023)[2]. It is an uncommon cancer, which is part of why it is missed.
Diagnosis turns on a proper look at the back of the eye. A dilated fundus examination, fundus photography and an eye ultrasound are the main tools used to assess a pigmented lesion Choroidal Melanoma: A Mini Review (2023)[3]. Where tissue is examined, it is read at the National Ophthalmic Pathology Laboratory in Dublin, and a mis-read there can delay the start of treatment.
Where the diagnosis is confirmed, treatment in Ireland includes plaque brachytherapy using ruthenium-106 or iodine-125, removal of the eye known as enucleation, and proton beam radiotherapy[1]. The aim of early treatment is to save the eye and vision where possible and to reduce the risk that the cancer spreads.
The Irish ocular melanoma referral pathway
Select a stage to see what should happen, and where a delay can occur.
What should happen. A dilated eye examination, with any pigmented lesion or sudden visual symptom noted, recorded and, where suspicious, referred on.
Where a delay can occur. A lesion is recorded as a harmless naevus and never reviewed, or symptoms are dismissed without a proper look at the back of the eye.
What should happen. Reported visual symptoms are taken seriously, and the patient is referred to ophthalmology where the cause is not clear.
Where a delay can occur. Symptoms are put down to ageing or migraine, and no referral is made.
What should happen. The lesion is assessed with imaging and ultrasound, and a suspected melanoma is referred to the national service without delay.
Where a delay can occur. A suspicious lesion is not followed up, or a scan or biopsy is misread.
What should happen. At the Royal Victoria Eye and Ear Hospital, the tumour is confirmed and treated promptly, with the aim of saving the eye and reducing the risk of spread.
Where a delay can occur. Any delay in reaching this stage can mean a larger tumour and fewer treatment options.
How an ocular melanoma diagnosis is missed or delayed
Symptoms are often vague, and some patients have none at all. When symptoms do appear, they include blurred vision, flashing lights, floaters and loss of part of the field of vision. About three in ten cases are found with no symptoms, on a routine eye check Choroidal Melanoma: A Mini Review (2023)[3]. This is why the examination, and the decision to refer, matter so much.
The findings and symptoms that should prompt a referral or close review include:
- New or worsening blurred or distorted vision in one eye
- Flashing lights or a sudden increase in floaters
- A shadow or loss of part of the field of vision
- A dark or growing spot on the coloured part of the eye
- A pigmented lesion at the back of the eye with high-risk features such as thickness, fluid under the retina or orange pigment
Most claims trace back to one of a few patterns. The table below sets out how a delay typically arises and why each pattern can fall below the expected standard.
| What happened | Why it can ground a claim |
|---|---|
| A pigmented lesion was seen but recorded as a benign naevus, with no monitoring and no referral | A competent practitioner would document the risk features and arrange review or referral rather than discharge the patient |
| Symptoms such as flashes, floaters or lost vision were attributed to ageing, migraine or a vitreous detachment, with no dilated examination of the back of the eye | The professional duty is to find a reason for the symptoms or to refer the patient on |
| A suspicious finding was noted but no referral to ophthalmology or the national ocular oncology service was made | This is a failure to refer for urgent investigation |
| An eye ultrasound, biopsy or histopathology result was misread or not acted on | A misread scan or biopsy delays the start of treatment |
| A naevus was identified and kept under review, but the reviews were too infrequent or did not include the imaging needed to detect growth | Monitoring a lesion carries a duty to monitor it well enough that growth is caught in time |
When a delay becomes negligence: the duty to refer and the Dunne test
Optometrists and opticians are regulated healthcare professionals in Ireland. Practising optometrists and dispensing opticians must register with the Optical Registration Board at CORU, the regulator for health and social care professionals Citizens Information (Updated 2025)[4]. That Board sets the Code of Professional Conduct and Ethics and the standards of performance for the professions CORU Optical Registration Board (Updated 2025)[5]. The regulator was established under the Health and Social Care Professionals Act 2005 Health and Social Care Professionals Act 2005[6]. An ophthalmologist, by contrast, is registered with the Irish Medical Council.
The legal standard is the Dunne test. Irish law judges a professional against the standard of a competent practitioner of similar skill, as set in Dunne v National Maternity Hospital [1989] IR 91[7]. A practitioner is not negligent simply because the diagnosis was missed. The question is whether no practitioner of equal standing, acting with ordinary care, would have managed the lesion or the symptoms in that way. The professional guidance reflects this. Optometry Ireland advises that it is incumbent on an optometrist to find a reason for blurred vision and, where no reason is found, to refer the patient on.
The duty does not end at the first look. Where a naevus is identified and kept under review, the reviews must be frequent enough, and use the right imaging, to catch growth in time. Monitoring a lesion poorly can be as much a breach as failing to refer it at all.
Proving causation and loss of chance
A claim needs proof that the delay caused harm, not just that a mistake was made. You must show that earlier diagnosis would have led to a better outcome, such as saving the eye, avoiding more aggressive treatment, or reducing the risk that the cancer spread. About half of uveal melanomas eventually spread, most often to the liver, even after the eye is treated[3].
Irish data show why timing matters. Access to eye care narrowed in 2020. Compared with 2019, melanomas treated at the Royal Victoria Eye and Ear Hospital were larger, more eyes were removed, and more had spread beyond the eye wall[2]. The size and growth of the tumour during any delay are therefore central questions.
The evidence comes from expert ophthalmic and oncology opinion on what the eye looked like, what a competent practitioner would have done, and what earlier treatment would have changed.
Loss of chance remains unsettled in Irish law. Where a delay reduced the prospect of a better outcome rather than clearly causing a defined harm, the courts have not spoken with one voice. Philp v Ryan [2004] IESC 105[8] and Quinn v Mid-Western Health Board [2005] IESC 19[9] are conflicting Supreme Court authorities on the point. Our page on loss of chance in cancer claims explains how this tension is argued, and our page on reduced life expectancy covers how a shortened prognosis is valued.
Who can be responsible for the delay
An eye-cancer claim can involve more than one defendant. Ireland uses a shared-care model, so the failure can sit with one professional or be spread across several. The optometrist or optician may be responsible where a lesion or symptom was missed, dismissed or not referred. The general practitioner may be responsible where reported visual symptoms were not acted on and no referral was made. The hospital or ophthalmology service may be responsible where a referral was delayed, a finding was not followed up, or a result was misread.
We often see the delay spread across more than one professional rather than sitting with a single person. Where more than one party had a role, a claim can be brought against each on the facts, and the court can apportion responsibility between them. Identifying who held responsibility at each step of the patient pathway is part of building the case, because it can open more than one route to compensation. For the general eye-care duty beyond cancer, see our wider guide to ophthalmology negligence claims.
What an ocular melanoma claim can include
Compensation in Ireland has two parts. General damages cover pain, suffering and the effect on your life. Special damages cover financial loss, such as the cost of treatment and care, travel, and lost earnings. General damages for clinical negligence are assessed under the Personal Injuries Guidelines, which the courts must apply Judicial Council Personal Injuries Guidelines (adopted 2021)[10]. Special damages are not capped and are added on top.
The Guidelines set brackets for sight and eye injuries. The figures below are illustrative ranges, not a prediction of any individual claim.
| Injury (illustrative) | Guidelines bracket |
|---|---|
| Loss of sight in one eye with reduced vision in the other | €120,000 to €300,000 |
| Total blindness in both eyes | €270,000 to €400,000 |
Where the eye is removed, or where the cancer has spread, the claim is assessed on its own facts. Where the eye is removed, the lasting effects include loss of the eye, the need for an artificial eye, and the change to side vision and depth perception that follows. The value of lost earnings, future care and a shortened prognosis can then form a large part of the total.
Eye-cancer claims also carry costs specific to sight loss. These can include an artificial eye and its upkeep, low-vision aids, and the cost of lifelong monitoring for spread. They can also cover travel to the national centre in Dublin, and retraining where the injury ends a career that depends on vision. Our cancer misdiagnosis compensation guide sets out how these elements are built.
Time limits and how the claim proceeds
You generally have two years less one day to start a claim. Time runs from your date of knowledge. That is when you first knew, or ought reasonably to have known, that you had a significant injury caused by the care you received. This comes from the limitation rules in the Civil Liability and Courts Act 2004[11] and the date-of-knowledge provisions in the Statute of Limitations (Amendment) Act 1991[12]. For a child, the two-year period does not begin until the child turns 18. Our pages on date of knowledge explain how this start date is worked out.
A medical negligence claim does not go through the Injuries Resolution Board. Clinical negligence claims are not assessed by the Injuries Resolution Board (IRB). They proceed in the High Court. A dedicated Clinical Negligence List now manages them under Practice Direction HC132, in effect from 28 April 2025 Courts Service: Clinical Negligence List (2025)[13]. The related Practice Direction HC131 sets out what must be in place before a trial date is fixed Courts Service: HC131 Trial Dates (2025)[14].
How we investigate and prove a claim
We start with the records and the right experts. In the cases we handle, the claim usually turns on one question: were the lesion or the symptoms ones a competent practitioner would have referred. We request the optometry records, GP notes and hospital file, including the eye images and any ultrasound or biopsy results.
We then ask an independent ophthalmologist, and an oncologist where the cancer has spread, to advise on three things. Was the lesion or symptom one that a competent practitioner would have referred or reviewed. If it had been acted on earlier, what treatment would have been possible. And what difference earlier treatment would have made to the eye, the vision and the prognosis.
This is detailed work, and it's fact-sensitive. In our experience, the strength of a claim turns on the eye findings recorded at the time, the quality of the records, and the expert view on causation. If you're unsure whether what happened to you was avoidable, we can review the papers and give you an honest assessment.
What to do if you think a diagnosis was missed
A few steps protect your position. If you think an eye melanoma was missed or diagnosed late, the steps below help you and any future claim.
- Ask for your records. Request your optometry notes, GP file and hospital records, including the eye photographs and any ultrasound or biopsy results.
- Note your date of knowledge. Write down when you first learned the diagnosis, and when you first suspected the earlier care was wrong.
- Get a specialist review. A second opinion from an ophthalmologist can clarify whether the lesion or symptoms should have been acted on sooner.
- Mind the time limit. You generally have two years less one day from your date of knowledge, so it helps to take advice early.
- Speak to a solicitor. A solicitor can request the records, instruct independent experts, and tell you whether there's a claim worth bringing.
Talk to a solicitor about an ocular melanoma claim. If you or a family member had a late or missed diagnosis of eye melanoma in Ireland, you can speak to us for a no obligation consultation. We'll listen, explain your options clearly, and tell you honestly whether there's a claim worth investigating.
Gary Matthews Solicitors, personal injury solicitors in Dublin, serving clients across Ireland.
Common questions
Can an optician be liable for missing eye cancer in Ireland?
Yes, on the right facts. Optometrists and dispensing opticians are regulated healthcare professionals, registered with the Optical Registration Board at CORU, and they owe a duty of care. A claim can arise where a suspicious lesion or symptom was missed, dismissed or not referred, and that delay caused avoidable harm. Whether the standard was breached is judged by the Dunne test, on expert evidence about what a competent practitioner would have done.
What is the difference between ocular melanoma and skin melanoma?
Ocular melanoma forms inside the eye, usually in the choroid at the back of the eye. Skin melanoma forms in the skin. They are different cancers with different pathways and different specialists. This page deals with eye melanoma. A missed skin lesion is covered on our melanoma and skin cancer page.
When does a freckle in the eye become suspicious?
A choroidal naevus is a common, usually harmless freckle inside the eye that is normally watched. It becomes suspicious when it shows higher-risk features, such as increasing thickness, fluid under the retina, related symptoms, or orange pigment. When those features are present, the expected step is closer review or referral rather than simply discharging the patient. Failing to act on those features can be the basis of a claim.
Is a delayed ocular melanoma diagnosis always negligent?
No. Eye melanoma is rare and can be symptomless, and not every delay is negligent. A claim depends on whether a competent practitioner, acting with ordinary care, would have detected or referred the problem at the time. It also depends on proving that earlier diagnosis would have led to a better outcome. Both questions are answered with independent expert evidence.
How is ocular melanoma diagnosed and treated in Ireland?
Diagnosis relies on a dilated examination of the back of the eye, fundus photography and an eye ultrasound. Since 2010, treatment has been centralised to one national centre, the Royal Victoria Eye and Ear Hospital in Dublin. Treatment options include plaque brachytherapy, removal of the eye, and proton beam radiotherapy, depending on the size and position of the tumour.
How long do I have to make an ocular melanoma claim in Ireland?
You generally have two years less one day from your date of knowledge. That is the date you first knew, or ought reasonably to have known, that you had a significant injury caused by the care you received. For a child, time does not start until the child turns 18. Because the start date can be hard to pin down, it's worth getting advice early.
Do I still have a claim if my eye had to be removed?
Yes. Removal of the eye, called enucleation, is a serious and permanent injury, and it can form part of a claim where an earlier diagnosis might have saved the eye. The claim would also cover the wider effects, such as the impact on your work, daily life and, where relevant, your prognosis. Each case is assessed on its own facts.
How much compensation could an ocular melanoma claim be worth?
There is no set figure, because it depends on the injury and its effect on your life. General damages for sight loss are assessed under the Personal Injuries Guidelines, with published brackets for loss of sight in one eye and for total blindness. Special damages, such as treatment, care and lost earnings, are not capped and are added on top. We can give you a realistic view once we have seen the records and medical evidence.
Can I claim for a child with an eye tumour?
Yes. A parent or guardian can bring a claim on a child's behalf, and the two-year period for the child does not begin until the child turns 18. Childhood eye cancer most often involves retinoblastoma rather than melanoma, and we are preparing a separate guide on that. For now, contact us and we can advise on the specific pathway.
What evidence does an ocular melanoma claim need?
The core evidence is the medical record, including the optometry notes, GP file, hospital records, eye images and any ultrasound or biopsy results. On top of that, the claim needs independent expert opinion on whether the lesion or symptom should have been referred, and on whether earlier treatment would have changed the outcome. We gather and organise this evidence as part of investigating the claim.
Is ocular melanoma curable?
The eye tumour itself can often be controlled, with treatments such as brachytherapy, proton beam radiotherapy or removal of the eye. The difficulty is that about half of people develop spread over time, most often to the liver, even after the eye is treated. Spread is much harder to treat, which is why finding the cancer early and small matters.
Can ocular melanoma make you go blind?
It can affect sight in the affected eye. The tumour, or the treatment used to control it, can reduce or destroy vision in that eye, and removing the eye ends vision in it. Sight in the other eye is usually not affected, although losing one eye changes side vision and depth perception.
Does ocular melanoma always spread?
No. Many people treated early never develop spread, and only a small number have detectable spread when the cancer is first found. Over the years that follow, up to about half can develop spread, most often to the liver. That is why long-term monitoring is part of care.
Why does an early ocular melanoma diagnosis matter?
Outcomes depend heavily on the size of the tumour and whether it has spread. Larger tumours and any spread carry worse prospects, so a delay that lets the tumour grow can reduce both treatment options and survival. This is the link between a missed diagnosis and the harm that a claim seeks to address.
Not sure if you have a claim? Many people are not certain whether a delay was avoidable. We can review the papers and tell you honestly. Speak to our cancer misdiagnosis team for a no obligation confidential call.
Key terms in an eye-cancer claim
A few terms come up often in these claims. Uveal melanoma is a cancer of the eye's middle layer. Choroidal melanoma is the most common form, found at the back of the eye. A choroidal naevus is a common, usually harmless freckle inside the eye.
Enucleation means surgical removal of the eye. A fundus examination is a look at the back of the eye, usually after dilating the pupil. Loss of chance describes a delay that reduced the prospect of a better outcome. Date of knowledge is when you first knew, or should have known, that your injury was caused by your care.
References
- Karwacka N and colleagues, Uveal Melanoma in Ireland, Ocular Oncology and Pathology, 2019. ncbi.nlm.nih.gov/pmc/articles/PMC6489068
- Mc Glacken-Byrne A and colleagues, Ocular oncology service during the COVID-19 outbreak, Irish Journal of Medical Science, 2023. ncbi.nlm.nih.gov/pmc/articles/PMC9938682
- Choroidal Melanoma: A Mini Review, Medicines, 2023. ncbi.nlm.nih.gov/pmc/articles/PMC9863301
- Citizens Information, Sight tests and eye health, updated 2025. citizensinformation.ie
- CORU, About the Optical Registration Board, updated 2025. coru.ie
- Health and Social Care Professionals Act 2005, Irish Statute Book. irishstatutebook.ie
- Dunne v National Maternity Hospital [1989] IR 91, Wikipedia. en.wikipedia.org
- Philp v Ryan [2004] IESC 105, BAILII. bailii.org/ie
- Quinn v Mid-Western Health Board [2005] IESC 19, BAILII. bailii.org/ie
- Judicial Council, Personal Injuries Guidelines, adopted 6 March 2021. judicialcouncil.ie
- Civil Liability and Courts Act 2004, Irish Statute Book. irishstatutebook.ie
- Statute of Limitations (Amendment) Act 1991, Irish Statute Book. irishstatutebook.ie
- Courts Service of Ireland, Clinical Negligence List (Practice Direction HC132), 2025. courts.ie
- Courts Service of Ireland, Clinical Negligence Actions Applications for Trial Dates (HC131), 2025. courts.ie
- Irish Cancer Society, Eye cancer information. cancer.ie
This information is for educational purposes only and does not constitute legal advice. Every case is different and depends on its own facts, and time limits are fact-sensitive. For advice on your own situation, please contact a solicitor. Gary Matthews Solicitors is regulated by the Law Society of Ireland. In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
Gary Matthews Solicitors
Medical negligence solicitors, Dublin
We help people every day of the week (weekends and bank holidays included) that have either been injured or harmed as a result of an accident or have suffered from negligence or malpractice.
Contact us at our Dublin office to get started with your claim today
