EYE PATHOLOGY

By

Dr. JUSUF FANTONI SpPA,MScPath(Glasg)

EYE PATHOLOGY

Eyelid
The eyelid is a composite of skin externally and a mucosa
(the conjunctiva) on the surface opposed to the eye. Aside from
protecting the eye, elements within the eyelid generate critical
components of the tear film. Accessory lacrimal glands, eccrine
and apocrine glands populate the eyelid. The sebaceous glands
( Zeis glands associated with the eyelash and the Meibomian
glands embedded within the eyelid fibrous tarsus ), which helps to
retard evaporation of tears. If the drainage system of the sebaceous
glands is obstructed by chronic inflammation at the eyelid margin
( blepharitis ), or by neoplasm, then lipid may extravasate into
surrounding tissue and provoke a granuloamtous response : a lipoGranuloma, or chalazion.

Neoplasm
The most common malignancy of the eyelid is basal
cell carcinoma. The second is sebaceous carcinoma, not S
C C. Surprisingly, primary melanomas of the eyelid skin
are extremely rare.
Eyelid neoplasms may distort tissue and prevent the
eyelids from closing completely. Exposure of the cornea is
not only painful, but also might predispose the patient to
corneal ulceration. B C C has a distinct predilection for the
lower eyelid and medial canthus.
Sebaceous carcinoma may mimic chalazion or may
diffusely thicken the eyelid.
Morphology
In moderately differentiated or well-differentiated sebaceous
carcinoma, vacuolization of the cytoplasm is present.

It may mimic B C C. Pagetoid spread may mimic

Bowenoid actinic keratosis in the eyelid and carcinoma in situ in the
conjunctiva. Sebaceous carcinoma may spread through the conjunctival
epithelium and the epidermis to the lacrima drainage system and the
nasopharynx

Cornea
Anteriorly, the cornea is covered by epithelium that
rests on a basement membrane. Bowmans layer, situated
just beneath the epithelial basement membrane, is
acellular and forms an efficient barrier against the
penetration of malignant cells from the epithelium into the
underlying stroma.
The corneal stroma lacks blood vessels and lymphatic
a featue that contributes to the transparancy of the
cornea.

The corneal endotehlium is derived from neural crest

and is related to vascular endothelium.
Keratitis and ulcers
Various pathogens --- bacterial, fungal, viral ( especially
herpes simplex and herpes zoster ), and protozoal
( Acanthamoeba) may cause corneal ulceration.
In al forms of keratitis, dissolution of the corneal stroma
may be accelerated by activationb of collagenenases within
corneal epithelium and stromal fibroblasts (=Keratocytes).
Neoplasms
The most common intraocular malignancy of adults is
metastasis to the uvea, typically to the choroid.

The appearance of metastases to the eye is suggestive of extremely short survival, and treatment of occular
metastases is usually palliative and delivered by radiation
therapy.
Uveal Nevi and Melanomas
Uveal melanoma is the most common primary intraocular
malignancy of adults. Incidence increases with age. Unlike cutaneous
melanoma, the occurrence of uveal melanoma has remained stable
over many years. The etiology of uveal melanoma is unresolved at
this time.
There are no lymphatics within the eye, hence, uveal
melanomas, with very rare exception, spread exclusively by a
hematogenous route ( the only exception being the rare case of
melanoma that spreads through the sclera and invades the conjuctiva,
thereby gaining access to conjunctival klynmphatics ). Most uveal
mnelanomas spread first to the liver.

Retina
Retinal Neoplasms
Retinoblastoma
= the most common primary intraocular malignancy of children.
The cell of origin of retinoblastoma is neuronal. Prognosis is
adversely affected by extraocular extension and invasion along the
optic nerve and possibly by choroidal invasion.
Retinoblastom occurs in individuals who inherit a germ-line
mutation of one RB allele. Retinoblastomas arising in the context of
germ line mutations not only may be bilateral, but also may be
associated with pinealoblastoma ( so called trilateral retinoblastoma)
Morphology
Tumors may contain both undifferentiated and differentiated
element. The former appear as collections of small, round cells with
hyperchromatic nuclei.

In well-differentiated tumors there Flexner-Wintersteiner

rosettes and fleurettes reflecting photoreceptor differentiation. It should
be noted, however, that the degree of tumor differentiation does not
appear to be associated with the prognosis.
Tumor cells are encircling tumor blood vessels with zones
of necrosis typically found in relatively avascular areas. This illustrates
graphically the dependance of retinoblastom on its blood supply.
Retinoblastom tends to spread to the brain and bone
marrow and seldom disseminates to the lungs.
A benign variant of retinoblastoma - retinocytoma -- has
been reported. The appearance of retinoblastoma in one eye and
retinocytoma in the other eye is characteristic of heritable
retinoblastoma.