Ophthalmic Pathology Emiko Furusato, M.D. Department of Neuropathology and Ophthalmic Pathology Armed 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 laterality 2.Measurements 3.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 vesselOptic nerve Vortex vein Inferior oblique muscle Superior oblique muscle

Posterior aspect of right eye Temporal sideNasal side Inferior oblique muscle Superior oblique muscleOptic nerve Long ciliary vessels

Anterior aspect of right eye Nasal side Temporal 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 LensCiliary bodyOptic 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 synechiaeCornea 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 membraneNerve fiber layerGanglion cell layerInner plexiform layerInner nuclear layerOuter plexiform layerOuter nuclear layerExternal 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