Difference between revisions of "Eye"

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[[Image:Gray888.png|thumb|200px|Illustration of the eye. (Gray's Anatomy/WC)]]
[[Image:Gray888.png|thumb|300px|Illustration of the eye. (Gray's Anatomy/WC)]]
[[Image:Optic nerve head and retina -- low mag.jpg|thumb|300px|Micrograph showing the optic nerve head and retina. [[H&E stain]]. (WC)]]
The '''eye''' is rarely seen by pathologists.  Typically, they go to neuropathologists, as the eye is really part of the brain.  The article also covers many of the lesions found around the eye.  The lacrimal gland is covered in the ''[[lacrimal gland]]'' article.  Eyelid lesions are covered in the ''[[eyelid]]'' article.   
The '''eye''' is rarely seen by pathologists.  Typically, they go to neuropathologists, as the eye is really part of the brain.  The article also covers many of the lesions found around the eye.  The lacrimal gland is covered in the ''[[lacrimal gland]]'' article.  Eyelid lesions are covered in the ''[[eyelid]]'' article.   


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*Surrounded by CSF.
*Surrounded by CSF.
*Covered by dura.
*Covered by dura.
====Images====
<gallery>
Image: Optic nerve -- very low mag.jpg | CN II - very low mag. (WC)
Image: Optic nerve -- low mag.jpg | CN II - low mag. (WC)
Image: Optic nerve -- intermed mag.jpg | CN II - intermed. mag. (WC)
Image: Optic nerve -- high mag.jpg | CN II - high mag. (WC)
</gallery>


===Inside to outside===
===Inside to outside===
Line 27: Line 36:
#Choroid.
#Choroid.
#Sclera.
#Sclera.
====Image====
<gallery>
Image:Optic nerve head and retina -- low mag.jpg| Optic nerve head and retina - low mag. (WC)
</gallery>


===Anterior angle===
===Anterior angle===
*Angle between cornea and iris.
*Angle between cornea and iris.
===Canthi===
The canthi are where the upper and lower eyelids meet:
*Medial canthus.
*Lateral canthus.
Note:
*The most common malignant canthus lesion is [[basal cell carcinoma]].<ref>URL: [https://iovs.arvojournals.org/article.aspx?articleid=2372910 https://iovs.arvojournals.org/article.aspx?articleid=2372910]. Accessed on: 2022 Nov 17.</ref>


=Histology=
=Histology=
Line 58: Line 80:


===Retina===
===Retina===
[[Image:Retina -- very high mag.jpg|thumb|right|300px|Retina. (WC)]]
Simplified structure - eosinophilic material separating:
Simplified structure - eosinophilic material separating:
#Intermediate size, round, pale-staining nuclei (ganglion cells).
#Intermediate size, round, pale-staining nuclei (ganglion cells).
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<gallery>
<gallery>
Image:Gray881.png | Retina - schematic. (WC/Gray's)
Image:Gray881.png | Retina - schematic. (WC/Gray's)
Image: Optic nerve head and retina -- low mag.jpg | Optic nerve & retina - low mag. (WC)
Image: Retina -- intermed mag.jpg | Retina - intermed. mag. (WC)
Image: Retina -- high mag.jpg | Retina - high mag. (WC)
</gallery>
</gallery>
www:
www:
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==Eccrine hidrocystoma==
==Eccrine hidrocystoma==
*Occasionally spelled ''eccrine hydrocystoma''.<ref name=pmid10065300/>
*Occasionally spelled ''eccrine hydrocystoma''.<ref name=pmid10065300/>
===General===
{{Main|Eccrine hidrocystoma}}
*Benign.
*Eyelid lesion.
 
Clinical DDx:<ref name=pmid10065300/>
*Cystic [[BCC]].
 
===Microsopic===
Features:<ref name=pmid15205675>{{Cite journal  | last1 = Singh | first1 = AD. | last2 = McCloskey | first2 = L. | last3 = Parsons | first3 = MA. | last4 = Slater | first4 = DN. | title = Eccrine hidrocystoma of the eyelid. | journal = Eye (Lond) | volume = 19 | issue = 1 | pages = 77-9 | month = Jan | year = 2005 | doi = 10.1038/sj.eye.6701404 | PMID = 15205675 }}</ref><ref>{{Ref Derm|314}}</ref>
*Cyst lined by a bland bilayer.
**Inner lining cells have:
***Small, round nuclei - usu. basal.
***Moderate pale/greyish cytoplasm.
***No apocrine snouts - flat surface.
**Outer lining cells - spindled.
***May be difficult to see.
 
Note:
*According to the CMAJ, it has the histology of an [[epidermal inclusion cyst]].<ref name=pmid10065300>{{Cite journal  | last1 = Adams | first1 = SP. | title = Dermacase. Eccrine hydrocystoma. | journal = Can Fam Physician | volume = 45 | issue =  | pages = 297, 306 | month = Feb | year = 1999 | doi =  | PMID = 10065300 |PMC = 2328272 }}</ref>
 
DDx:
*[[Apocrine hidrocystoma]] - have apocrine snouts; surface is ''not'' flat.
*Cystadenoma - has epithelial proliferation.
 
====Image====
<gallery>
Image:SkinTumors-P7110453.JPG | Apocrine hidrocystoma (AH). AH looks similar to ''eccrine hidrocystoma''. (WC)
</gallery>
www:
*[http://www.nature.com/eye/journal/v19/n1/fig_tab/6701404f1.html Eccrine hidrocystoma (nature.com)].
*[http://www.dermnet.org.nz/pathology/apocrine-hidrocystoma-path.html Apocrine hidrocystoma (dermnet.org)].
*[http://www.flickr.com/photos/42574434@N03/9519309216 Apocrine hidrocystoma (flickr.com)].
 
===Sign out===
<pre>
SKIN LESION, ADJACENT TO RIGHT EYELID, EXCISION:
- ECCRINE HIDROCYSTOMA.
</pre>
 
====Micro====
The sections show hair bearing skin with a cyst lined by a bland bilayered epithelium.  The predominant lining cell has moderate pale grey cytoplasm and a small round nucleus. 
 
The lesion is excised in the plane of section.


==Chalazion==
==Chalazion==
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==Papilloma of the caruncle==
==Papilloma of the caruncle==
*[[AKA]] ''caruncle papilloma''.
{{Main|Eye papilloma}}
===General===
 
*Benign.
==Corneal ulcer==
*Second most common caruncle tumour ~ 15% of caruncle tumours.<ref name=pmid16935590>{{Cite journal  | last1 = Kaeser | first1 = PF. | last2 = Uffer | first2 = S. | last3 = Zografos | first3 = L. | last4 = Hamédani | first4 = M. | title = Tumors of the caruncle: a clinicopathologic correlation. | journal = Am J Ophthalmol | volume = 142 | issue = 3 | pages = 448-55 | month = Sep | year = 2006 | doi = 10.1016/j.ajo.2006.04.035 | PMID = 16935590 }}</ref>
{{Main|Corneal ulcer}}
**Most common is [[nevus]] ~ 50% of caruncle tumours.


===Gross===
==Keratoconus==
*Frond-like lesion.
{{Main|Keratoconus}}


Image:
==Corneal scar==
*[http://www.atlasophthalmology.com/atlas/photo.jsf?node=2748&locale=en Papilloma of caruncle (atlasophthalmology.com)].
===General===
*Trauma to the cornea.


===Microscopic===
===Microscopic===
Features:<ref name=pmid16935590/>
Features:
*Fibrovascular fronds in a cauliflower-like arrangement.
*Compact hyaline tissue - darker staining.
*No nuclear atypia.
*Fibroblasts.


Image:
DDx:
*[http://www.atlasophthalmology.com/atlas/photo.jsf?node=4686&locale=en Papilloma of caruncle - crappy image (atlasophthalmology.com)].  
*Squamous dysplasia.


===Sign out===
===Sign out===
<pre>
<pre>
LESION, RIGHT CARUNCLE, EXCISION:
Corneal Button, Right Eye, Keratoplasty:
- PAPILLOMA.
- Consistent with corneal scar.
- NEGATIVE FOR MALIGNANCY.
- NEGATIVE for dysplasia.
</pre>
</pre>


====Micro====
==Conjunctival nevus==
The sections show benign conjunctival mucosa and a lesion consisting of fibrovascular
{{Main|Conjunctival nevus}}
cores covered by a conjunctival epithelium with a cauliflower-like appearance at low
power. Parakeratosis is present. No significant nuclear atypia is identified. No koilocytic
change is seen. No mitotic activity is appreciated.


===External links===
=Tumours of the eye=
*[http://eyewiki.aao.org/Conjunctival_Papilloma Conjunctival papilloma (eyewiki.aao.org)].
==Optic glioma==
===General===
*Associated with [[Neurofibromatosis]] type 1.
* Often nerve sheath thickening or tortuosity.
* Approx 3% of all pediatric gliomas.
* Histology in most cases a [[pilocytic astrocytoma]].


=Malignant entities=
==Retinoblastoma==
==Retinoblastoma==
===General===
{{Main|Retinoblastoma}}
*Rare.
*Malignant.
*May be familial.<ref name=pmid20687510>{{cite journal |author=Lohmann D |title=Retinoblastoma |journal=Adv. Exp. Med. Biol. |volume=685 |issue= |pages=220–7 |year=2010 |pmid=20687510 |doi= |url=}}</ref>
 
===Gross===
*White, solid.
*Patterns:
**Endophytic - grow into the  vitreous cavity.
**Exophytic - grow toward choroid.
**Mixed - components of endophytic and exophytic.
 
Image:
*[http://radiopaedia.org/cases/retinoblastoma-gross-pathology Retinoblastoma (radiopaedia.org/AFIP)].
 
Note:
*Tumour is extremely friable.
 
===Microscopic===
Features:
*[[Small round cell tumour]]:
**Scant cytoplasm.
*Flexner-Wintersteiner [[rosette]] - '''key feature'''.
**Rosette with empty centre (donut hole).<ref name=pmid16551982>{{cite journal |author=Wippold FJ, Perry A |title=Neuropathology for the neuroradiologist: rosettes and pseudorosettes |journal=AJNR Am J Neuroradiol |volume=27 |issue=3 |pages=488–92 |year=2006 |month=March |pmid=16551982 |doi= |url=}}</ref>
*+/-Homer-Wright rosette.<ref>WH. 14 March 2011.</ref>
**Circular rosette with neuropil at the centre.<ref name=pmid16551982>{{cite journal |author=Wippold FJ, Perry A |title=Neuropathology for the neuroradiologist: rosettes and pseudorosettes |journal=AJNR Am J Neuroradiol |volume=27 |issue=3 |pages=488–92 |year=2006 |month=March |pmid=16551982 |doi= |url=}}</ref>
*Mitoses - common.
*+/-Necrosis.
*+/-Calcification.
 
DDx:
*Retinocytoma (retinoma) - benign counterpart of retinoblastoma.
 
Notes:
*DDx of Flexner-Wintersteiner rosette includes:
**Pineoblastoma.
**Medulloepithelioma.
 
Image:
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/O0A001-PQ01-M.htm Retinoblastoma (ouhsc.edu)].
*[http://www.pathpedia.com/Education/eAtlas/Histopathology/eye_and_ocular_adnexa/retinoblastoma.aspx Retinoblastoma (pathpedia.com)].


==Malignant melanoma==
==Malignant melanoma==

Latest revision as of 17:39, 17 November 2022

Illustration of the eye. (Gray's Anatomy/WC)
Micrograph showing the optic nerve head and retina. H&E stain. (WC)

The eye is rarely seen by pathologists. Typically, they go to neuropathologists, as the eye is really part of the brain. The article also covers many of the lesions found around the eye. The lacrimal gland is covered in the lacrimal gland article. Eyelid lesions are covered in the eyelid article.

An introduction to neuropathology is in the neuropathology article.

Procedures

  • Evisceration - eye muscles left intact.
  • Enucleation.
  • Exenteration - extensive resection.

Anatomy

Anterior to posterior

  1. Cornea.
  2. Iris.
  3. Lens.
  4. Conjunctiva - edge of cornea.
  5. Sclera.

Optic nerve

  • Surrounded by CSF.
  • Covered by dura.

Images

  • CN II - very low mag. (WC)

  • CN II - low mag. (WC)

  • CN II - intermed. mag. (WC)

  • CN II - high mag. (WC)

Inside to outside

  1. Retina.
  2. Retinal pigment epithelium (RPE).
  3. Choroid.
  4. Sclera.

Image

  • Optic nerve head and retina - low mag. (WC)

Anterior angle

  • Angle between cornea and iris.

Canthi

The canthi are where the upper and lower eyelids meet:

  • Medial canthus.
  • Lateral canthus.

Note:

Histology

Eye muscles

  • The muscles that move the eye have a high nerve:muscle ratio = ~1:4.[2]
    • Other muscles in the body ~1:250.

Conjunctiva

Features:[3]

  • Stratified squamous.
    • May be stratified columnar
  • Goblet cells.

Cornea

Layers:[4]

  1. Epithelium layer.
    • Squamoid cells.
  2. Bowman's layer.
    • Indistinct.
  3. Stroma.
    • Fibrous tissue.
    • No blood vessels.
  4. Descemet’s layer.
    • Indistinct.
    • PAS -ve.
  5. Endothelium.
    • Single layer.

Retina

Retina. (WC)

Simplified structure - eosinophilic material separating:

  1. Intermediate size, round, pale-staining nuclei (ganglion cells).
  2. Two layers of small round nuclei (inner and outer nuclear layer).
  3. Eosinophilic ellipsoid structures - rods/cones (photoreceptors).
  4. Single layer of cuboidal cells (retinal pigment epithelium.

Detailed structure - in direction light travels:

  1. Inner limiting membrane.
  2. Nerve fibre layer.
  3. Ganglion layer.
  4. Inner plexiform layer.
  5. Inner nuclear layer.
  6. Outer plexiform layer.
  7. Outer nuclear layer.
  8. Layer of rods and cones.
  9. External limiting membrane.
  10. Retinal pigment epithelium.

Images

  • Retina - schematic. (WC/Gray's)

  • Optic nerve & retina - low mag. (WC)

  • Retina - intermed. mag. (WC)

  • Retina - high mag. (WC)

www:

Eye structures with melanocytes

Melanoma may arise from these sites:

  • Iris.
  • Conjunctiva.
  • Ciliary bodies.
  • Choroid.

Benign entities

Conjunctivitis

General

  • Benign.
  • Never biopsied.
    • It is an incidental finding in a biopsy for something else.

Gross

  • Red eye.

Microscopic

Features:

  • Conjunctival epithelium - stratified squamous epithelium with goblet cells.
  • Inflammatory cells.

Conjunctival cyst

Conjunctival cyst
External resources
EHVSC 10173

General

  • Rare.
  • May be due to surgery, trauma, or congenital (very rare).[5]

Microscopic

Features:

  • Conjunctival mucosa with atypia.
    • Stratified squamous epithelium with goblet cells.

DDx:

Image:

Sign out

CONJUNCTIVA, RIGHT SUPERIOR, BIOPSY:
- BENIGN CONJUNCTIVAL MUCOSA -- COMPATIBLE WITH CYST LINIG.

Pinguecula

  • Plural Pingueculae.

General

  • Raizada et al.[7] suggest it is an early pterygium; however, this is disputed.
  • Due to ultraviolet light exposure, e.g. sunlight.[8]
  • Tend to be older than individuals afflicted with a pterygium.

Gross

  • Yellow spot.

Microscopic

Features:

  • Similar to pterygium.[8]

Pterygium

  • AKA surfer eye.
Main article: Pterygium

Eccrine hidrocystoma

  • Occasionally spelled eccrine hydrocystoma.[9]
Main article: Eccrine hidrocystoma

Chalazion

Main article: Chalazion

Retinal hemorrhage

See Traumatic brain injury in infants.

Image:

Glaucoma

General

  • Leading cause of irreversible blindness.

Classification:

  • Open angle - more common.
  • Closed angle.

Microscopic

Features (closed angle):

  • Cornea and iris opposed to one another.

Retinal detachment

General

  • Blindness.

Causes:

  • Trauma (classic) - pathologist doesn't usually see.
  • Tumours - common in pathology specimens.

Microscopic

Features:

  • Retina separated from retinal pigment epithelium.
  • Eosinophilic exudate containing macrophages.

Blepharochalasis

General

  • Rare, benign eyelid disorder.[11]
  • Upper eyelids +/-lower eyelids (severe cases).[11]

Clinical:

  • Swelling of eyelids - recurrent.[12]
  • Onset in childhood.
  • Leads to ptosis.

Clinical DDx:[11]

  • Recurrent angioedema.
  • Hereditary angioedema.
  • Contact dermatitis.
  • Melkersson-Rosenthal syndrome.
  • Dermatochalasis.
  • Floppy-eyelid syndrome.
  • Lax eyelid syndrome.
  • Cutis laxa.

Note:

  • The term may be abused; it may be used when an eyelid tuck is done for other reasons.[citation needed]

Microscopic

Features:[11]

  • Edema.

DDx:

Stains

  • Elastin stain - shows loss of elastin.[14]

Sign out

EYELID, LEFT UPPER, PTOSIS REPAIR:
- SQUAMOUS EPITHELIUM WITHIN NORMAL LIMITS.
- SUBEPITHELIAL TISSUE WITH MILD EDEMA.
- SOLAR ELASTOSIS.
- NEGATIVE FOR MALIGNANCY.

Lower eyelids in an older individual labelled blepharochalasis

A. EYELID, LEFT LOWER, BLEPHAROPLASTY:
- BENIGN SKIN WITH MILD SOLAR ELASTOSIS.
- BENIGN SKELETAL MUSCLE AND ADIPOSE TISSUE.
- NEGATIVE FOR MALIGNANCY.

B. EYELID, RIGHT LOWER, BLEPHAROPLASTY:
- BENIGN SKIN WITH MILD SOLAR ELASTOSIS.
- BENIGN SKELETAL MUSCLE AND ADIPOSE TISSUE.
- NEGATIVE FOR MALIGNANCY.

Papilloma of the caruncle

Main article: Eye papilloma

Corneal ulcer

Main article: Corneal ulcer

Keratoconus

Main article: Keratoconus

Corneal scar

General

  • Trauma to the cornea.

Microscopic

Features:

  • Compact hyaline tissue - darker staining.
  • Fibroblasts.

DDx:

  • Squamous dysplasia.

Sign out

Corneal Button, Right Eye, Keratoplasty:
- Consistent with corneal scar.
- NEGATIVE for dysplasia.

Conjunctival nevus

Main article: Conjunctival nevus

Tumours of the eye

Optic glioma

General

Retinoblastoma

Main article: Retinoblastoma

Malignant melanoma

Main article: Malignant melanoma

Common malignancy in the eye in adults.

See also

References

  1. ↑ URL: https://iovs.arvojournals.org/article.aspx?articleid=2372910. Accessed on: 2022 Nov 17.
  2. ↑ Bilbao. 24 November 2010.
  3. ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/corepages/eye/eye.htm. Accessed on: 20 October 2011.
  4. ↑ URL: http://www.ophthobook.com/questions/question-name-the-layers-of-the-cornea-and-their-function. Accessed on: 26 January 2012.
  5. ↑ Robb, RM.; Elliott, AT.; Robson, CD. (Apr 2012). "Developmental conjunctival cyst of the eyelid in a child.". J AAPOS 16 (2): 196-8. doi:10.1016/j.jaapos.2012.02.001. PMID 22525180.
  6. ↑ Elshazly, LH. (Jan 2011). "A clinicopathologic study of excised conjunctival lesions.". Middle East Afr J Ophthalmol 18 (1): 48-54. doi:10.4103/0974-9233.75886. PMID 21572734.
  7. ↑ Raizada, IN.; Bhatnagar, NK. (Jul 1976). "Pinguecula and pterygium (a histopathological study).". Indian J Ophthalmol 24 (2): 16-8. PMID 1031388.
  8. ↑ 8.0 8.1 Hill, JC.; Maske, R. (1989). "Pathogenesis of pterygium.". Eye (Lond) 3 ( Pt 2): 218-26. doi:10.1038/eye.1989.31. PMID 2695353.
  9. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid10065300
  10. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html. Accessed on: 6 December 2010.
  11. ↑ 11.0 11.1 11.2 11.3 Koursh, DM.; Modjtahedi, SP.; Selva, D.; Leibovitch, I.. "The blepharochalasis syndrome.". Surv Ophthalmol 54 (2): 235-44. doi:10.1016/j.survophthal.2008.12.005. PMID 19298902.
  12. ↑ Bergin, DJ.; McCord, CD.; Berger, T.; Friedberg, H.; Waterhouse, W. (Nov 1988). "Blepharochalasis.". Br J Ophthalmol 72 (11): 863-7. PMID 3207663.
  13. ↑ Wang, G.; Li, C.; Gao, T. (Apr 2009). "Blepharochalasis: a rare condition misdiagnosed as recurrent angioedema.". Arch Dermatol 145 (4): 498-9. doi:10.1001/archdermatol.2009.19. PMID 19380685.
  14. ↑ Kaneoya, K.; Momota, Y.; Hatamochi, A.; Matsumoto, F.; Arima, Y.; Miyachi, Y.; Shinkai, H.; Utani, A. (Jan 2005). "Elastin gene expression in blepharochalasis.". J Dermatol 32 (1): 26-9. PMID 15841657.
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