ophthalmic pathology emiko furusato, m.d. department of neuropathology and ophthalmic pathology...

Ophthalmic Pathology

Emiko Furusato, M.D.

Department of Neuropathology and Ophthalmic PathologyArmed Forces Institute of Pathology

A joint conference with MAPA and PANE 2009

Contents

• Grossing the globe• Ocular histology• 10 Representative cases

Grossing the ocular specimen

• Four basic steps

1. Orient the specimen and determine laterality2. Measurements3. Transillumination (TI)4. Sectioning the globe

Grossing the ocular specimen

• 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

1. Orient the specimen and determine laterality

Posterior aspect of left eye

Temporal side Nasal side

Long ciliary vessel

Optic nerve

Vortex vein

Inferior oblique muscle

Superior oblique muscle

Posterior aspect of right eye

Temporal sideNasal sideNasal side

Inferior oblique muscle

Superior oblique muscleOptic nerve

Long ciliary vessels

Anterior aspect of right eye

Nasal sideTemporal side

Horizontal diameter :11 mm

Vertical diameter: 10mm

Grossing the ocular specimen

• 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

2. Measurements

Grossing the ocular specimen 3.Transillumination (TI)

Grossing the ocular specimen

• Transilluminated prior to dissection. • Use dissecting microscope illuminator in a darkened

room.• Applications

– Uveal malignant melanoma – Dark shadow on the sclera

3.Transillumination (TI)

Pupil

Dark band of ciliary body

Pigmented tumor show round shadow

Ciliochroidal melanoma

Retinal detachment

Lens

Ciliary body

Optic nerve

Grossing the ocular specimen

Initial cut: Cornea side down

Superior calotte

Optic nerve

4.Sectioning for the globe

Pupillary Optic nerve (PO) section

Inferior calotte

Second cut: Cut surface down

Grossing the ocular specimen

4.Sectioning the globe

Inferior calotte

Grossing the ocular specimen

4.Sectioning the globe

Retinal detachment

Posterior synechiae

Cornea

Lens

Choroid Subretinal exudate

Ocular Histology

• Conjunctiva• Cornea • Iris / Ciliary body• Lens• Retina• Choroid

Ocular Histology

•Conjunctiva‒ Epithelium, goblet cells‒ Stroma

•Topographic zones‒ Tarsal (palpebral)‒ Fornix ‒ Bulbar

Histology: Conjunctiva

Ocular Histology

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

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 epithelium-Pigmented 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

–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)

10 Representative cases

Conjunctival Cases

Case 1