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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 lesions found around the eye.  The lacrimal gland is covered in the ''[[lacrimal gland]]'' article.   
[[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.   


An introduction to neuropathology is in the ''[[neuropathology]]'' article.
An introduction to neuropathology is in the ''[[neuropathology]]'' article.
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#Conjunctiva - edge of cornea.
#Conjunctiva - edge of cornea.
#Sclera.
#Sclera.
#*Similar to cornea - normally has blood vessels.
#*Similar to cornea - normally has [[blood vessel]]s.


===Optic nerve===
===Optic nerve===
*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===
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#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=
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#Endothelium.
#Endothelium.
#*Single layer.
#*Single layer.
===Retina===
[[Image:Retina -- very high mag.jpg|thumb|right|300px|Retina. (WC)]]
Simplified structure - eosinophilic material separating:
#Intermediate size, round, pale-staining nuclei (ganglion cells).
#Two layers of small round nuclei (inner and outer nuclear layer).
#Eosinophilic ellipsoid structures - rods/cones (photoreceptors).
#Single layer of cuboidal cells (retinal pigment epithelium.
Detailed structure - in direction light travels:
#Inner limiting membrane.
#Nerve fibre layer.
#Ganglion layer.
#Inner plexiform layer.
#Inner nuclear layer.
#Outer plexiform layer.
#Outer nuclear layer.
#Layer of rods and cones.
#External limiting membrane.
#Retinal pigment epithelium.
====Images====
<gallery>
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>
www:
*[http://www.surgical-pathology.com/retina_image.htm Retina - histology (surgical-pathology.com)].
*[http://biology.clc.uc.edu/fankhauser/labs/anatomy_&_physiology/a&p202/special_senses/eye/histology_eye.htm Histology of the eye (clc.uc.edu)].


===Eye structures with melanocytes===
===Eye structures with melanocytes===
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*Conjunctival epithelium - stratified squamous epithelium with goblet cells.
*Conjunctival epithelium - stratified squamous epithelium with goblet cells.
*Inflammatory cells.
*Inflammatory cells.
==Conjunctival cyst==
{{ Infobox external links
| Name          = Conjunctival cyst
| EHVSC          = 10173
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
===General===
*Rare.
*May be due to surgery, trauma, or congenital (very rare).<ref>{{Cite journal  | last1 = Robb | first1 = RM. | last2 = Elliott | first2 = AT. | last3 = Robson | first3 = CD. | title = Developmental conjunctival cyst of the eyelid in a child. | journal = J AAPOS | volume = 16 | issue = 2 | pages = 196-8 | month = Apr | year = 2012 | doi = 10.1016/j.jaapos.2012.02.001 | PMID = 22525180 }}</ref>
===Microscopic===
Features:
*Conjunctival mucosa with atypia.
**Stratified squamous epithelium with goblet cells.
DDx:
*Ocular surface squamous neoplasia.
**Cystic [[squamous cell carcinoma]].
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085152/figure/F0003/ Conjunctival cyst (nih.gov)].<ref name=pmid21572734>{{Cite journal  | last1 = Elshazly | first1 = LH. | title = A clinicopathologic study of excised conjunctival lesions. | journal = Middle East Afr J Ophthalmol | volume = 18 | issue = 1 | pages = 48-54 | month = Jan | year = 2011 | doi = 10.4103/0974-9233.75886 | PMID = 21572734 }}</ref>
===Sign out===
<pre>
CONJUNCTIVA, RIGHT SUPERIOR, BIOPSY:
- BENIGN CONJUNCTIVAL MUCOSA -- COMPATIBLE WITH CYST LINIG.
</pre>


==Pinguecula==
==Pinguecula==
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===General===
===General===
*Raizada ''et al.''<ref name=pmid1031388>{{Cite journal  | last1 = Raizada | first1 = IN. | last2 = Bhatnagar | first2 = NK. | title = Pinguecula and pterygium (a histopathological study). | journal = Indian J Ophthalmol | volume = 24 | issue = 2 | pages = 16-8 | month = Jul | year = 1976 | doi =  | PMID = 1031388 | URL = http://www.ijo.in/text.asp?2007/55/1/83/29517 }}</ref> suggest it is an early pterygium; however, this is disputed.
*Raizada ''et al.''<ref name=pmid1031388>{{Cite journal  | last1 = Raizada | first1 = IN. | last2 = Bhatnagar | first2 = NK. | title = Pinguecula and pterygium (a histopathological study). | journal = Indian J Ophthalmol | volume = 24 | issue = 2 | pages = 16-8 | month = Jul | year = 1976 | doi =  | PMID = 1031388 | URL = http://www.ijo.in/text.asp?2007/55/1/83/29517 }}</ref> suggest it is an early [[pterygium]]; however, this is disputed.
*Due to ultraviolet light exposure, e.g. sunlight.<ref name=pmid2695353>{{Cite journal  | last1 = Hill | first1 = JC. | last2 = Maske | first2 = R. | title = Pathogenesis of pterygium. | journal = Eye (Lond) | volume = 3 ( Pt 2) | issue =  | pages = 218-26 | month =  | year = 1989 | doi = 10.1038/eye.1989.31 | PMID = 2695353 | URL = http://www.nature.com/eye/journal/v3/n2/abs/eye198931a.html }}</ref>
*Due to ultraviolet light exposure, e.g. sunlight.<ref name=pmid2695353>{{Cite journal  | last1 = Hill | first1 = JC. | last2 = Maske | first2 = R. | title = Pathogenesis of pterygium. | journal = Eye (Lond) | volume = 3 ( Pt 2) | issue =  | pages = 218-26 | month =  | year = 1989 | doi = 10.1038/eye.1989.31 | PMID = 2695353 | URL = http://www.nature.com/eye/journal/v3/n2/abs/eye198931a.html }}</ref>
*Tend to be older than individuals afflicted with a pterygium.
*Tend to be older than individuals afflicted with a pterygium.
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==Pterygium==
==Pterygium==
*[[AKA]] surfer eye.
*[[AKA]] surfer eye.
===General===
{{Main|Pterygium}}
*Pronounced: "tuh-rij-ee-uhm".<ref>URL: [http://dictionary.reference.com/browse/pterygium http://dictionary.reference.com/browse/pterygium]. Accessed on: 20 October 2011</ref>
*Conjunctiva lesion that covers part of the sclera.
**Sclera = white part of the eye.<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002006/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002006/]. Accessed on: 20 October 2011.</ref>
*Benign.
*Due to ultraviolet light exposure, i.e. sunlight.<ref name=pmid2695353>{{Cite journal  | last1 = Hill | first1 = JC. | last2 = Maske | first2 = R. | title = Pathogenesis of pterygium. | journal = Eye (Lond) | volume = 3 ( Pt 2) | issue =  | pages = 218-26 | month =  | year = 1989 | doi = 10.1038/eye.1989.31 | PMID = 2695353 | URL = http://www.nature.com/eye/journal/v3/n2/abs/eye198931a.html }}</ref>
 
===Gross===
*Medial aspect of eye - covers sclera (white part) and part of the iris (coloured part).
 
Image:
*[http://trialx.com/curebyte/2011/05/31/what-does-pterygium-look-like/ Pterygium - gross (trialx.com)].
 
===Microscopic===
Features:<ref name=pmid2695353>{{Cite journal  | last1 = Hill | first1 = JC. | last2 = Maske | first2 = R. | title = Pathogenesis of pterygium. | journal = Eye (Lond) | volume = 3 ( Pt 2) | issue =  | pages = 218-26 | month =  | year = 1989 | doi = 10.1038/eye.1989.31 | PMID = 2695353 | URL = http://www.nature.com/eye/journal/v3/n2/abs/eye198931a.html }}</ref>
*Hyaline material beneath epithelium.
*Elastic fibres beneath the hyaline material.
*+/-Inflammation.
*[[Solar elastosis]].<ref name=uic_edu>URL: [http://www.uic.edu/depts/mcpt/eyepath/specco4.htm http://www.uic.edu/depts/mcpt/eyepath/specco4.htm]. Accessed on: 25 October 2011.</ref>
**Dense gray/light brown acellular material.
*Dilated vessels.<ref name=uic_edu>URL: [http://www.uic.edu/depts/mcpt/eyepath/specco4.htm http://www.uic.edu/depts/mcpt/eyepath/specco4.htm]. Accessed on: 25 October 2011.</ref>
 
DDx:
*Squamous dysplasia.
 
Images:
*www:
**[http://www.uic.edu/depts/mcpt/eyepath/specco4.htm Pterygium (uic.edu)].
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Pterygium_-_intermed_mag.jpg Pterygium - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Pterygium_-_high_mag.jpg Pterygium - high mag. (WC)].


==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:
*Same histology as [[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>


==Chalazion==
==Chalazion==
===General===
{{Main|Chalazion}}
*Benign eye thing.
 
===Microscopic===
Features:
*Granulomatous inflammation<ref name=pmid15029054>{{Cite journal  | last1 = D'hermies | first1 = F. | last2 = Fayet | first2 = B. | last3 = Meyer | first3 = A. | last4 = Morel | first4 = X. | last5 = Halhal | first5 = M. | last6 = Elmaleh | first6 = C. | last7 = Azan | first7 = F. | last8 = Behar-Cohen | first8 = F. | last9 = Renard | first9 = G. | title = [Chalazion mimicking an eyelid tumor]. | journal = J Fr Ophtalmol | volume = 27 | issue = 2 | pages = 202-5 | month = Feb | year = 2004 | doi =  | PMID = 15029054 }}</ref> +/- [[Touton giant cell]]s.<ref>URL: [http://emedicine.medscape.com/article/1212709-workup http://emedicine.medscape.com/article/1212709-workup]. Accessed on: 9 February 2012.</ref>
**Around clear space (lipid).
*Plasma cells - abundant - '''important'''.
 
Image:
*[http://www.surgical-pathology.com/chala.JPG Chalazion (surgical-pathology.com)].<ref>URL: [http://www.surgical-pathology.com/chalazion.htm http://www.surgical-pathology.com/chalazion.htm]. Accessed on: 24 January 2012.</ref>
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170139555 Chalazion (surgicalpathologyatlas.com)].


==Retinal hemorrhage==
==Retinal hemorrhage==
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*Eosinophilic exudate containing macrophages.
*Eosinophilic exudate containing macrophages.


=Malignant entities=
==Blepharochalasis==
==Retinoblastoma==
===General===
===General===
*Rare.
*Rare, benign eyelid disorder.<ref name=pmid19298902>{{Cite journal | last1 = Koursh | first1 = DM. | last2 = Modjtahedi | first2 = SP. | last3 = Selva | first3 = D. | last4 = Leibovitch | first4 = I. | title = The blepharochalasis syndrome. | journal = Surv Ophthalmol | volume = 54 | issue = 2 | pages = 235-44 | month = | year = | doi = 10.1016/j.survophthal.2008.12.005 | PMID = 19298902 }}</ref>
*Malignant.
*Upper eyelids +/-lower eyelids (severe cases).<ref name=pmid19298902/>
*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===
Clinical:
*White, solid.
*Swelling of eyelids - recurrent.<ref>{{Cite journal  | last1 = Bergin | first1 = DJ. | last2 = McCord | first2 = CD. | last3 = Berger | first3 = T. | last4 = Friedberg | first4 = H. | last5 = Waterhouse | first5 = W. | title = Blepharochalasis. | journal = Br J Ophthalmol | volume = 72 | issue = 11 | pages = 863-7 | month = Nov | year = 1988 | doi = | PMID = 3207663 }}</ref>
*Patterns:
*Onset in childhood.
**Endophytic - grow into the vitreous cavity.
*Leads to ptosis.
**Exophytic - grow toward choroid.
**Mixed - components of endophytic and exophytic.


Image:
Clinical DDx:<ref name=pmid19298902/>
*[http://radiopaedia.org/cases/retinoblastoma-gross-pathology Retinoblastoma (radiopaedia.org/AFIP)].
*Recurrent angioedema.
*Hereditary angioedema.
*[[Contact dermatitis]].
*Melkersson-Rosenthal syndrome.
*Dermatochalasis.
*Floppy-eyelid syndrome.
*Lax eyelid syndrome.
*Cutis laxa.


Note:
Note:
*Tumour is extremely friable.
*The term may be abused; it may be used when an eyelid tuck is done for other reasons.{{fact}}
 
===Microscopic===
Features:<ref name=pmid19298902>{{Cite journal  | last1 = Koursh | first1 = DM. | last2 = Modjtahedi | first2 = SP. | last3 = Selva | first3 = D. | last4 = Leibovitch | first4 = I. | title = The blepharochalasis syndrome. | journal = Surv Ophthalmol | volume = 54 | issue = 2 | pages = 235-44 | month =  | year =  | doi = 10.1016/j.survophthal.2008.12.005 | PMID = 19298902 }}</ref>
*Edema.
 
DDx:
*Angioedema.<ref name=pmid19380685>{{Cite journal  | last1 = Wang | first1 = G. | last2 = Li | first2 = C. | last3 = Gao | first3 = T. | title = Blepharochalasis: a rare condition misdiagnosed as recurrent angioedema. | journal = Arch Dermatol | volume = 145 | issue = 4 | pages = 498-9 | month = Apr | year = 2009 | doi = 10.1001/archdermatol.2009.19 | PMID = 19380685 }}</ref>
 
===Stains===
*Elastin stain - shows loss of elastin.<ref name=pmid15841657>{{Cite journal  | last1 = Kaneoya | first1 = K. | last2 = Momota | first2 = Y. | last3 = Hatamochi | first3 = A. | last4 = Matsumoto | first4 = F. | last5 = Arima | first5 = Y. | last6 = Miyachi | first6 = Y. | last7 = Shinkai | first7 = H. | last8 = Utani | first8 = A. | title = Elastin gene expression in blepharochalasis. | journal = J Dermatol | volume = 32 | issue = 1 | pages = 26-9 | month = Jan | year = 2005 | doi =  | PMID = 15841657 }}</ref>
 
===Sign out===
<pre>
EYELID, LEFT UPPER, PTOSIS REPAIR:
- SQUAMOUS EPITHELIUM WITHIN NORMAL LIMITS.
- SUBEPITHELIAL TISSUE WITH MILD EDEMA.
- SOLAR ELASTOSIS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Lower eyelids in an older individual labelled blepharochalasis====
<pre>
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.
</pre>
 
==Papilloma of the caruncle==
{{Main|Eye papilloma}}
 
==Corneal ulcer==
{{Main|Corneal ulcer}}
 
==Keratoconus==
{{Main|Keratoconus}}
 
==Corneal scar==
===General===
*Trauma to the cornea.


===Microscopic===
===Microscopic===
Features:
Features:
*[[Small round cell tumour]]:
*Compact hyaline tissue - darker staining.
**Scant cytoplasm.
*Fibroblasts.
*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:
DDx:
*Retinocytoma (retinoma) - benign counterpart of retinoblastoma.
*Squamous dysplasia.
 
===Sign out===
<pre>
Corneal Button, Right Eye, Keratoplasty:
- Consistent with corneal scar.
- NEGATIVE for dysplasia.
</pre>
 
==Conjunctival nevus==
{{Main|Conjunctival nevus}}


Notes:
=Tumours of the eye=
*DDx of Flexner-Wintersteiner rosette includes:
==Optic glioma==
**Pineoblastoma.
===General===
**Medulloepithelioma.
*Associated with [[Neurofibromatosis]] type 1.
* Often nerve sheath thickening or tortuosity.
* Approx 3% of all pediatric gliomas.
* Histology in most cases a [[pilocytic astrocytoma]].


Image:
==Retinoblastoma==
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/O0A001-PQ01-M.htm Retinoblastoma (ouhsc.edu)].
{{Main|Retinoblastoma}}
*[http://www.pathpedia.com/Education/eAtlas/Histopathology/eye_and_ocular_adnexa/retinoblastoma.aspx Retinoblastoma (pathpedia.com)].


==Malignant melanoma==
==Malignant melanoma==
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*[[Lacrimal gland]].
*[[Lacrimal gland]].
*[[Neuropathology]].
*[[Neuropathology]].
*[[Descemet's membrane]].


=References=
=References=
{{Reflist|2}}
{{Reflist|2}}


[[Category:Weird stuff]]
[[Category:Eye]]
[[Category:Neuropathology]]
[[Category:Neuropathology]]
Michael
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