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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.


==Histology==
=Procedures=
*Evisceration - eye muscles left intact.
*Enucleation.
*Exenteration - extensive resection.
 
=Anatomy=
===Anterior to posterior===
#Cornea.
#Iris.
#Lens.
#Conjunctiva - edge of cornea.
#Sclera.
#*Similar to cornea - normally has [[blood vessel]]s.
 
===Optic nerve===
*Surrounded by CSF.
*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===
#Retina.
#Retinal pigment epithelium (RPE).
#Choroid.
#Sclera.
 
====Image====
<gallery>
Image:Optic nerve head and retina -- low mag.jpg| Optic nerve head and retina - low mag. (WC)
</gallery>
 
===Anterior angle===
*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=
===Eye muscles===
*The muscles that move the eye have a high nerve:muscle ratio = ~1:4.<ref>Bilbao. 24 November 2010.</ref>
*The muscles that move the eye have a high nerve:muscle ratio = ~1:4.<ref>Bilbao. 24 November 2010.</ref>
**Other muscles in the body ~1:250.
**Other muscles in the body ~1:250.


Conjunctiva:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/eye/eye.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/eye/eye.htm]. Accessed on: 20 October 2011.</ref>
===Conjunctiva===
Features:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/eye/eye.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/eye/eye.htm]. Accessed on: 20 October 2011.</ref>
*Stratified squamous.
*Stratified squamous.
**May be stratified columnar
**May be stratified columnar
*Goblet cells.  
*Goblet cells.
 
===Cornea===
Layers:<ref>URL: [http://www.ophthobook.com/questions/question-name-the-layers-of-the-cornea-and-their-function http://www.ophthobook.com/questions/question-name-the-layers-of-the-cornea-and-their-function]. Accessed on: 26 January 2012.</ref>
#Epithelium layer.
#*Squamoid cells.
#Bowman's layer.
#*Indistinct.
#Stroma.
#*Fibrous tissue.
#*No blood vessels.
#Descemet’s layer.
#*Indistinct.
#*PAS -ve.
#Endothelium.
#*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.


==Pterygium==
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===
[[Melanoma]] may arise from these sites:
*Iris.
*Conjunctiva.
*Ciliary bodies.
*Choroid.
 
=Benign entities=
==Conjunctivitis==
===General===
===General===
*Scleral lesion
**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.
*Benign.
*Assoc. with sun exposure.
*Never biopsied.
**It is an incidental finding in a biopsy for something else.
 
===Gross===
*Red eye.


Image:
===Microscopic===
*[http://trialx.com/curebyte/2011/05/31/what-does-pterygium-look-like/ Pterygium - gross (trialx.com)].
Features:
*Conjunctival epithelium - stratified squamous epithelium with goblet 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===
===Microscopic===
Features:
Features:
*Dilated vessels.
*Conjunctival mucosa with atypia.
*Solar elastosis.
**Stratified squamous epithelium with goblet cells.
**Dense gray/light brown acellular material.


DDx:
DDx:
*Squamous dysplasia.
*Ocular surface squamous neoplasia.
**Cystic [[squamous cell carcinoma]].


Image:
Image:
*[http://www.uic.edu/depts/mcpt/eyepath/specco4.htm Pterygium (uic.edu)].
*[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==
*Plural ''Pingueculae''.
 
===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.
*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.
 
===Gross===
*Yellow spot.
 
===Microscopic===
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>
 
==Pterygium==
*[[AKA]] surfer eye.
{{Main|Pterygium}}


==Eccrine hidrocystoma==
==Eccrine hidrocystoma==
*Occasionally spelled ''eccrine hydrocystoma''.<ref name=pmid10065300/>
{{Main|Eccrine hidrocystoma}}
==Chalazion==
{{Main|Chalazion}}
==Retinal hemorrhage==
:See ''[[Traumatic brain injury in infants]]''.
Image:
*[http://library.med.utah.edu/WebPath/jpeg2/FOR124.jpg Retinal haemorrhage (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html]. Accessed on: 6 December 2010.</ref>
==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===
===General===
*Benign.
*Blindness.
*Eyelid lesion.


Clinical DDx:<ref name=pmid10065300/>
Causes:
*Cystic [[BCC]].
*Trauma (classic) - pathologist doesn't usually see.
*Tumours - common in pathology specimens.


===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>
*Retina separated from retinal pigment epithelium.
*Eosinophilic exudate containing macrophages.
 
==Blepharochalasis==
===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.
 
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>


==Retinoblastoma==
===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===
===General===
*Rare.
*Trauma to the cornea.
*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>


===Microscopic===
===Microscopic===
Features:
Features:
*[[Small round cell tumour]].
*Compact hyaline tissue - darker staining.
*Flexner-Wintersteiner [[rosette]] - '''key feature'''.
*Fibroblasts.
**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>


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


==Retinal hemorrhage==
==Retinoblastoma==
:See ''[[Traumatic brain injury in infants]]''.
{{Main|Retinoblastoma}}


Image:
==Malignant melanoma==
*[http://library.med.utah.edu/WebPath/jpeg2/FOR124.jpg Retinal haemorrhage (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html]. Accessed on: 6 December 2010.</ref>
{{Main|Malignant melanoma}}
Common malignancy in the eye in adults.


==See also==
=See also=
*[[CNS tumours]].
*[[Hypertension]].
*[[Hypertension]].
*[[Lacrimal gland]].
*[[Neuropathology]].
*[[Neuropathology]].
*[[CNS tumours]].
*[[Descemet's membrane]].


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


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