Ophthalmic Pathology - midatlanticpas.org

Ophthalmic Pathology - midatlanticpas.org

A joint conference with MAPA and PANE 2009 Ophthalmic Pathology Emiko Furusato, M.D. Department of Neuropathology and Ophthalmic Pathology Armed Forces Institute of Pathology Contents

Grossing the globe Ocular histology 10 Representative cases Grossing the ocular specimen Four basic steps 1. 2. 3.

4. Orient the specimen and determine laterality Measurements Transillumination (TI) Sectioning the globe Grossing the ocular specimen 1. Orient the specimen and determine laterality

Anatomic landmarks that orient the specimen Cornea: Horizontal meridian is wider Long posterior ciliary vessels: Blue line marks horizontal meridian posteriorly Inferior oblique: Inferotemporal quadrant, nasal end near fovea, no tendon Superior oblique: Superiorly and temporally, shiny tendinous insertion

Superior oblique muscle Long ciliary vessel Optic nerve Temporal side Nasal side

Inferior oblique muscle Vortex vein Posterior aspect of left eye Superior oblique muscle Optic nerve

Nasal Nasal sideside Temporal side Inferior oblique muscle Long ciliary vessels

Posterior aspect of right eye Horizontal diameter :11 mm Nasal side Temporal side Vertical diameter: 10mm

Anterior aspect of right eye Grossing the ocular specimen 2. Measurements Globe: AP (antero-posterior including the cornea), Horizontal, Vertical, length of the optic nerve Normal eye (24 mm = one inch) in diameter

Cornea: Horizontal and vertical planes 12 (horizontal) x11mm (vertical) or 11X10mm. Diameter of pupil Note dimensions of any lesions such as wounds, tumors, etc Grossing the ocular specimen 3.Transillumination (TI)

Grossing the ocular specimen 3.Transillumination (TI) Transilluminated prior to dissection. Use dissecting microscope illuminator in a darkened room. Applications Uveal malignant melanoma Dark shadow on the sclera

Dark band of ciliary body Pupil Pigmented tumor show round shadow Ciliochroidal melanoma Lens

Ciliary body Optic nerve Retinal detachment Grossing the ocular specimen 4.Sectioning for the globe Pupillary Optic nerve (PO) section

Optic nerve Superior calotte Inferior calotte Initial cut: Cornea side down

Grossing the ocular specimen 4.Sectioning the globe Inferior calotte Second cut: Cut surface down Grossing the ocular specimen 4.Sectioning the globe

Posterior synechiae Cornea Lens Retinal detachment Choroid

Subretinal exudate Ocular Histology

Conjunctiva Cornea Iris / Ciliary body Lens Retina Choroid Ocular Histology

Histology: Conjunctiva Conjunctiva Epithelium, goblet cells Stroma Topographic zones Tarsal (palpebral)

Fornix Bulbar Ocular Histology Histology: Cornea Epithelium Nonkeratinizing, 5-layered

Bowmans layer Thick collagenous layer underlying the basal cell basement membrane Stroma Collagen lamellae secreted by fibroblasts interrupted by large artifactual clefts Descemets membrane Endothelium

Single layer of cuboidal cells Ocular Histology Histology: Iris & Ciliary body Iris (anterior to posterior 4 zone) Anterior border layer

Stroma Partially pigmented epithelium Completely pigmented posterior pigment epithelium Sphinctor muscle appears as a ring in the pupillary stroma Ciliary body - Nonpigmented ciliary epithelium - Pigmented ciliary epithelium - Stroma, ciliary muscle

Histology : Iris/ ciliary body Iris Anterior limiting layer-Stroma Sphincter pupillae Pigment epithelium( double layer) Ciliary body

Nonpigmented epitheliumPigmented epithelium-Stroma, ciliary muscle Ocular Histology Histology : Lens Lens capsule Anterior: single-layer, cuboidal, inverted lens epithelium secretes

the overlying thick basemembrane Posterior: No epithelium therefore, remains thinner than anterior capsule Lens cortex and nucleus Layers of lens cells (fibers) that become compressed as they move inward

Ocular Histology Histology : Retina Internal limiting membrane Nerve fiber layer Ganglion cell layer Inner plexiform layer Inner nuclear layer

Outer plexiform layer Outer nuclear layer External limiting membrane Photoreceptors, Rods and cones Retinal pigment epithelium Histology : Choroid/Sclera Choroid Bruchs membrane

Choriocapillaris Chroidal stroma Suprachroidal (potential) space Sclera Stroma Episclera Physiologically thin

( limbus, behind the insertion of the rectus muscles and around Optic nerve) 10 Representative cases Conjunctival Cases

Case 1

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