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The '''eye''' is rarely seen by pathologists.  They go to neuropathologists.   
[[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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*Evisceration - eye muscles left intact.
*Evisceration - eye muscles left intact.
*Enucleation.
*Enucleation.
*Exenteration.
*Exenteration - extensive resection.


=Anatomy=
=Anatomy=
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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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#Descemet’s layer.
#Descemet’s layer.
#*Indistinct.
#*Indistinct.
#*PAS _ve.
#*PAS -ve.
#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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=Benign entities=
=Benign entities=
==Pinguecula==
==Conjunctivitis==
*Plural ''Pingueculae''.
 
===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.
*Benign.
*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>
*Never biopsied.
*Tend to be older than individuals afflicted with a pterygium.
**It is an incidental finding in a biopsy for something else.


===Gross===
===Gross===
*Yellow spot.
*Red eye.


===Microscopic===
===Microscopic===
Features:
Features:
*Similar to pterygium.<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>
*Conjunctival epithelium - stratified squamous epithelium with goblet cells.
*Inflammatory cells.


==Pterygium==
==Conjunctival cyst==
*[[AKA]] surfer eye.
{{ Infobox external links
| Name          = Conjunctival cyst
| EHVSC          = 10173
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
===General===
===General===
*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>
*Rare.
*Conjunctiva lesion that covers part of the sclera.
*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>
**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>
 
Image:
*[http://trialx.com/curebyte/2011/05/31/what-does-pterygium-look-like/ Pterygium - gross (trialx.com)].


===Microscopic===
===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>
Features:
*Hyaline material beneath epithelium.
*Conjunctival mucosa with atypia.
*Elastic fibres beneath the hyaline material.
**Stratified squamous epithelium with goblet cells.
*+/-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:
DDx:
*Squamous dysplasia.
*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>


Images:
==Pinguecula==
*www:
*Plural ''Pingueculae''.
**[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==
===General===
===General===
*Benign.
*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.
*Eyelid lesion.
*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.


Clinical DDx:<ref name=pmid10065300/>
===Gross===
*Cystic [[BCC]].
*Yellow spot.


===Microsopic===
===Microscopic===
Features:
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>
*Similar to pterygium.<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>


==Chalazion==
==Pterygium==
===General===
*[[AKA]] surfer eye.
*Benign eye thing.
{{Main|Pterygium}}


===Microscopic===
==Eccrine hidrocystoma==
Features:
*Occasionally spelled ''eccrine hydrocystoma''.<ref name=pmid10065300/>
*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>
{{Main|Eccrine hidrocystoma}}
**Around clear space (lipid).
*Plasma cells.


Image:
==Chalazion==
*[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>
{{Main|Chalazion}}
*[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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*Cornea and iris opposed to one another.
*Cornea and iris opposed to one another.


=Malignant entities=
==Retinal detachment==
==Retinoblastoma==
===General===
===General===
*Rare.
*Blindness.
*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>
Causes:
*Trauma (classic) - pathologist doesn't usually see.
*Tumours - common in pathology specimens.


===Microscopic===
===Microscopic===
Features:
Features:
*[[Small round cell tumour]].
*Retina separated from retinal pigment epithelium.
*Flexner-Wintersteiner [[rosette]] - '''key feature'''.
*Eosinophilic exudate containing macrophages.
**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>  
==Blepharochalasis==
**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>
===General===
*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>
*Upper eyelids +/-lower eyelids (severe cases).<ref name=pmid19298902/>
 
Clinical:
*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>
*Onset in childhood.
*Leads to ptosis.
 
Clinical DDx:<ref name=pmid19298902/>
*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.{{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.


Image:
DDx:
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/O0A001-PQ01-M.htm Retinoblastoma (ouhsc.edu)].
*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}}


Notes:
==Corneal ulcer==
*DDx of Flexner-Wintersteiner rosette includes: pineoblastomas, medulloepitheliomas.
{{Main|Corneal ulcer}}


=Malignant melanoma=
==Keratoconus==
{{Main|Malignant melanoma}}
{{Main|Keratoconus}}
Common malignancy in the eye in adults.


===Retinal detachment===
==Corneal scar==
===General===
===General===
*Blindness.
*Trauma to the cornea.
 
Causes:
*Trauma (classic).
*Tumours - common in pathology specimens.


===Microscopic===
===Microscopic===
Features:
Features:
*Retina separated from retinal pigment epithelium.
*Compact hyaline tissue - darker staining.
*Eosinophilic exudate containing macrophages.
*Fibroblasts.
 
DDx:
*Squamous dysplasia.
 
===Sign out===
<pre>
Corneal Button, Right Eye, Keratoplasty:
- Consistent with corneal scar.
- NEGATIVE for dysplasia.
</pre>
 
==Conjunctival nevus==
{{Main|Conjunctival nevus}}
 
=Tumours of the eye=
==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]].
 
==Retinoblastoma==
{{Main|Retinoblastoma}}
 
==Malignant melanoma==
{{Main|Malignant melanoma}}
Common malignancy in the eye in adults.


=See also=
=See also=
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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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