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Ophthalmic Pathology

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.

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Ophthalmic Pathology

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

  2. Contents • Grossing the globe • Ocular histology • 10 Representative cases

  3. Grossing the ocular specimen • Four basic steps • Orient the specimen and determine laterality • Measurements • Transillumination (TI) • Sectioning the globe

  4. 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

  5. Superior oblique muscle Long ciliary vessel Optic nerve Temporal side Nasal side Inferior oblique muscle Vortex vein Posterior aspect of left eye

  6. Superior oblique muscle Optic nerve Nasal side Nasal side Temporal side Inferior oblique muscle Long ciliary vessels Posterior aspect of right eye

  7. Horizontal diameter :11 mm Nasal side Temporal side Vertical diameter: 10mm Anterior aspect of right eye

  8. 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

  9. Grossing the ocular specimen 3.Transillumination (TI)

  10. 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

  11. Dark band of ciliary body Pupil Pigmented tumor show round shadow

  12. Ciliochroidal melanoma Lens Ciliary body Optic nerve Retinal detachment

  13. 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

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

  15. Grossing the ocular specimen 4.Sectioning the globe Posterior synechiae Cornea Lens Retinal detachment Choroid Subretinal exudate

  16. Ocular Histology • Conjunctiva • Cornea • Iris / Ciliary body • Lens • Retina • Choroid

  17. Ocular Histology

  18. Histology: Conjunctiva Conjunctiva Epithelium, goblet cells Stroma Topographic zones Tarsal (palpebral) Fornix Bulbar

  19. Ocular Histology

  20. Histology: Cornea • Epithelium • Nonkeratinizing, 5-layered • Bowman’s layer • Thick collagenous layer underlying the basal cell basement membrane • Stroma • Collagen lamellae secreted by fibroblasts interrupted by large artifactual clefts • Descemet’s membrane • Endothelium • Single layer of cuboidal cells

  21. Ocular Histology

  22. 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

  23. Histology : Iris/ ciliary body Iris Anterior limiting layer’-Stroma Sphincter pupillae Pigment epithelium( double layer) Ciliary body Nonpigmented epithelium-Pigmented epithelium’-Stroma, ciliary muscle

  24. Ocular Histology

  25. 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

  26. Ocular Histology

  27. 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

  28. Histology : Choroid/Sclera Choroid Bruch’s membrane Choriocapillaris Chroidal stroma Suprachroidal (potential) space • Sclera • Stroma • Episclera • Physiologically thin( limbus, behind the insertion of the rectus muscles and around Optic nerve)

  29. 10 Representative cases

  30. Conjunctival Cases

  31. Case 1

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