EYE PATHOLOGY
Robbins and Cotran Patho Basis of Disease 10th Ed.
*use at your own risk
TRANS BY: SM
DISEASE DESCRIPTION PATHOGENESIS MORPHOLOGY CLINICAL FEATURES TREATMENT
ORBIT
FUNCTIONAL ANATOMY: orbit is a compartment that is closed medially, laterally, and posteriorly
PROPTOSIS - PROPTOSIS - displacement of the eye forward from diseases that increase orbital contents
- proptotic eye not be covered completely by the eyelids, tear film not distributed evenly across the cornea
- Chronic corneal exposure to air is injurious, lead to pain and corneal ulceration and infection
- Proptosis may be axial (directly forward) or positional
- Proptosis (displaced inferior/medial) due to enlargement of lacrimal gland from inflammation (sarcoidosis) or neoplasm (lymphoma, pleomorphic adenoma, or adenoid cystic carcinoma)
- axial proptosis: the eye bulges straight forward from masses within the cone by the horizontal rectus muscles
two most common primary tumors of the optic nerve (a tract of the central nervous system):
- glioma and meningioma
- produce axial proptosis (optic nerve is positioned within the muscle cone)
THYROID OPHTHALMOPATHY - axial proptosis is an important clinical manifestation of Grave’s disease
(GRAVES DISEASE) - Proptosis is caused by the accumulation of ECM proteins and fibrosis in the rectus muscles
- development of thyroid ophthalmopathy may be independent of the status of thyroid function.
OTHER ORBITAL - floor of the orbit is the roof of the maxillary sinus
INFLAMMATORY - lamina papyracea- medial wall of the orbit separates orbit from the ethmoidal sinuses
CONDITIONS - uncontrolled sinus infection may spread to the orbit either as an acute bacterial infection or as a component of a fungal infection
- occurs most commonly in immunosuppressed individuals, patients with DKA, or in persons w/o any predisposition
- granulomatosis with polyangiitis may present first in the orbit for prolonged periods of time or it may involve the orbit secondarily by extension from the sinuses
- another inflammatory condition affecting the orbit - characterized by chronic inflammation and variable degrees of fibrosis
Idiopathic orbital - unilateral or bilateral - Inflammatory infiltrate includes lymphocytes and plasma cells and occasionally eosinophils.
inflammation / orbital - affect all orbital tissue elements or may be confined to the lacrimal gland (sclerosing dacryoadenitis), - Germinal centers raise the suspicion of a reactive lymphoid hyperplasia
Inflammatory pseudotumor extraocular muscles (orbital myositis), or Tenon capsule, the fascial layer that wraps around the eye - Vasculitis may be present (underlying systemic condition)
(posterior scleritis) - presence of necrosis and degenerating collagen should raise the suspicion of granulomatosis with
- IgG4-related disease should be excluded before declaring an orbital inflammation to be idiopathic. polyangiitis
- typically confined to the orbit but may develop concomitantly with sclerosing inflammation in p[the
retroperitoneum, the mediastinum, and the thyroid, especially as a manifestation of IgG4-related
disease.
NEOPLASM most frequently are vascular in origin:
- capillary hemangioma of infancy and early childhood (unencapsulated)
- lymphangioma (unencapsulated)
- encapsulated cavernous hemangioma found typically in adults
- Only a handful of orbital masses are encapsulated (e.g., pleomorphic adenoma of the lacrimal gland, dermoid cyst, neurilemmoma)
- recognition of encapsulation allows the surgeon to anticipate pathologic findings
- Non-Hodgkin lymphoma affect the entire orbit or can be confined to compartments of the orbit such as the lacrimal gland
- Orbital lymphomas are classified according to the WHO) classification system
1
, Primary orbital malignancies
- may arise from any of the orbital tissues and are classified according to the scheme used for the parent tissue
- the lacrimal gland may be considered a minor salivary gland, and tumors of the lacrimal gland are classified as salivary gland tumors.
Metastases
- present with distinctive signs and symptoms that point to the origin of the tumor
- metastatic prostatic carcinoma present clinically like idiopathic orbital inflammation
- metastatic neuroblastoma and Wilms tumor produce characteristic periocular ecchymoses
- Neoplasms may also invade from the sinuses into the orbit.
EYELID
FUNCTIONAL ANATOMY - composed of skin externally and mucosa (the conjunctiva) on the surface
- addition to covering and protecting the eye, elements in the eyelid generate critical components of the tear film
- the drainage system of the sebaceous glands is obstructed by chronic inflammation at the eyelid margin (blepharitis)
less commonly, by neoplasm, lipid may extravasate and provoke a granulomatous response producing a lipogranuloma, or chalazion.
NEOPLASM - BASAL CELL CARCINOMA - most common malignancy of the eyelid moderately differentiated / well-differentiated sebaceous carcinoma - chronic exposure to air damages
- primary melanomas of the eyelid skin are extremely rare - vacuolization of the cytoplasm is present the cornea, prompt treatment
- eyelid neoplasms may distort tissue and prevent the eyelids from closing completely - helps in the diagnosis imperative to preserve vision
- Basal cell CA has distinct predilection for the lower eyelid and the medial canthus - may resemble a variety of other malignancies (basal cell carcinoma)
so establishing the correct diagnosis can be difficult
Sebaceous carcinoma
- form a local mass that mimics chalazion or may diffusely thicken the eyelid Pagetoid spread
- may also resemble inflammatory processes such as blepharitis or ocular cicatricial pemphigoid - may mimic Bowenoid actinic keratosis in the eyelid and carcinoma in
because of a predilection for intraepithelial spread situ in the conjunctiva
- tends to spread first to the parotid and submandibular nodes
- overall mortality rate 22% Sebaceous carcinoma
- less likely to be associated with Muir-Torre syndrome than sebaceous neoplasms developing - may spread through the conjunctival epithelium and the epidermis to
elsewhere the lacrimal drainage system and the nasopharynx
- it may also extend into the lacrimal gland ductules and into the
- individuals with AIDS, Kaposi sarcoma may develop in eyelid or conjunctiva lacrimal gland.
- eyelid lesion may appear purple hue (lesion is embedded in the dermis)
- conjunctiva, appears bright red
CONJUNCTIVA
FUNCTIONAL ANATOMY - divided into zones, each with distinctive histologic features and responses to disease
PALPEBRAL CONJUNCTIVA
- conjunctiva lining the interior of the eyelid
- tightly tethered to the tarsus
- may respond to inflammation by being thrown into minute papillary folds (as w/ allergic conjunctivitis and bacterial conjunctivitis)
FORNIX
- a pseudostratified columnar epithelium rich in goblet cells.
- contains accessory lacrimal tissue, ductules of the fornix superiorly and laterally
- Lymphoid population is most noticeable in the fornix
- in viral conjunctivitis, lymphoid follicles may enlarge sufficiently to be visualized clinically by slit-lamp examination
- Granulomas-associated with systemic sarcoidosis detected here
- yield of granulomas from biopsy in individuals suspected of sarcoid is as high as 50%.
2
Robbins and Cotran Patho Basis of Disease 10th Ed.
*use at your own risk
TRANS BY: SM
DISEASE DESCRIPTION PATHOGENESIS MORPHOLOGY CLINICAL FEATURES TREATMENT
ORBIT
FUNCTIONAL ANATOMY: orbit is a compartment that is closed medially, laterally, and posteriorly
PROPTOSIS - PROPTOSIS - displacement of the eye forward from diseases that increase orbital contents
- proptotic eye not be covered completely by the eyelids, tear film not distributed evenly across the cornea
- Chronic corneal exposure to air is injurious, lead to pain and corneal ulceration and infection
- Proptosis may be axial (directly forward) or positional
- Proptosis (displaced inferior/medial) due to enlargement of lacrimal gland from inflammation (sarcoidosis) or neoplasm (lymphoma, pleomorphic adenoma, or adenoid cystic carcinoma)
- axial proptosis: the eye bulges straight forward from masses within the cone by the horizontal rectus muscles
two most common primary tumors of the optic nerve (a tract of the central nervous system):
- glioma and meningioma
- produce axial proptosis (optic nerve is positioned within the muscle cone)
THYROID OPHTHALMOPATHY - axial proptosis is an important clinical manifestation of Grave’s disease
(GRAVES DISEASE) - Proptosis is caused by the accumulation of ECM proteins and fibrosis in the rectus muscles
- development of thyroid ophthalmopathy may be independent of the status of thyroid function.
OTHER ORBITAL - floor of the orbit is the roof of the maxillary sinus
INFLAMMATORY - lamina papyracea- medial wall of the orbit separates orbit from the ethmoidal sinuses
CONDITIONS - uncontrolled sinus infection may spread to the orbit either as an acute bacterial infection or as a component of a fungal infection
- occurs most commonly in immunosuppressed individuals, patients with DKA, or in persons w/o any predisposition
- granulomatosis with polyangiitis may present first in the orbit for prolonged periods of time or it may involve the orbit secondarily by extension from the sinuses
- another inflammatory condition affecting the orbit - characterized by chronic inflammation and variable degrees of fibrosis
Idiopathic orbital - unilateral or bilateral - Inflammatory infiltrate includes lymphocytes and plasma cells and occasionally eosinophils.
inflammation / orbital - affect all orbital tissue elements or may be confined to the lacrimal gland (sclerosing dacryoadenitis), - Germinal centers raise the suspicion of a reactive lymphoid hyperplasia
Inflammatory pseudotumor extraocular muscles (orbital myositis), or Tenon capsule, the fascial layer that wraps around the eye - Vasculitis may be present (underlying systemic condition)
(posterior scleritis) - presence of necrosis and degenerating collagen should raise the suspicion of granulomatosis with
- IgG4-related disease should be excluded before declaring an orbital inflammation to be idiopathic. polyangiitis
- typically confined to the orbit but may develop concomitantly with sclerosing inflammation in p[the
retroperitoneum, the mediastinum, and the thyroid, especially as a manifestation of IgG4-related
disease.
NEOPLASM most frequently are vascular in origin:
- capillary hemangioma of infancy and early childhood (unencapsulated)
- lymphangioma (unencapsulated)
- encapsulated cavernous hemangioma found typically in adults
- Only a handful of orbital masses are encapsulated (e.g., pleomorphic adenoma of the lacrimal gland, dermoid cyst, neurilemmoma)
- recognition of encapsulation allows the surgeon to anticipate pathologic findings
- Non-Hodgkin lymphoma affect the entire orbit or can be confined to compartments of the orbit such as the lacrimal gland
- Orbital lymphomas are classified according to the WHO) classification system
1
, Primary orbital malignancies
- may arise from any of the orbital tissues and are classified according to the scheme used for the parent tissue
- the lacrimal gland may be considered a minor salivary gland, and tumors of the lacrimal gland are classified as salivary gland tumors.
Metastases
- present with distinctive signs and symptoms that point to the origin of the tumor
- metastatic prostatic carcinoma present clinically like idiopathic orbital inflammation
- metastatic neuroblastoma and Wilms tumor produce characteristic periocular ecchymoses
- Neoplasms may also invade from the sinuses into the orbit.
EYELID
FUNCTIONAL ANATOMY - composed of skin externally and mucosa (the conjunctiva) on the surface
- addition to covering and protecting the eye, elements in the eyelid generate critical components of the tear film
- the drainage system of the sebaceous glands is obstructed by chronic inflammation at the eyelid margin (blepharitis)
less commonly, by neoplasm, lipid may extravasate and provoke a granulomatous response producing a lipogranuloma, or chalazion.
NEOPLASM - BASAL CELL CARCINOMA - most common malignancy of the eyelid moderately differentiated / well-differentiated sebaceous carcinoma - chronic exposure to air damages
- primary melanomas of the eyelid skin are extremely rare - vacuolization of the cytoplasm is present the cornea, prompt treatment
- eyelid neoplasms may distort tissue and prevent the eyelids from closing completely - helps in the diagnosis imperative to preserve vision
- Basal cell CA has distinct predilection for the lower eyelid and the medial canthus - may resemble a variety of other malignancies (basal cell carcinoma)
so establishing the correct diagnosis can be difficult
Sebaceous carcinoma
- form a local mass that mimics chalazion or may diffusely thicken the eyelid Pagetoid spread
- may also resemble inflammatory processes such as blepharitis or ocular cicatricial pemphigoid - may mimic Bowenoid actinic keratosis in the eyelid and carcinoma in
because of a predilection for intraepithelial spread situ in the conjunctiva
- tends to spread first to the parotid and submandibular nodes
- overall mortality rate 22% Sebaceous carcinoma
- less likely to be associated with Muir-Torre syndrome than sebaceous neoplasms developing - may spread through the conjunctival epithelium and the epidermis to
elsewhere the lacrimal drainage system and the nasopharynx
- it may also extend into the lacrimal gland ductules and into the
- individuals with AIDS, Kaposi sarcoma may develop in eyelid or conjunctiva lacrimal gland.
- eyelid lesion may appear purple hue (lesion is embedded in the dermis)
- conjunctiva, appears bright red
CONJUNCTIVA
FUNCTIONAL ANATOMY - divided into zones, each with distinctive histologic features and responses to disease
PALPEBRAL CONJUNCTIVA
- conjunctiva lining the interior of the eyelid
- tightly tethered to the tarsus
- may respond to inflammation by being thrown into minute papillary folds (as w/ allergic conjunctivitis and bacterial conjunctivitis)
FORNIX
- a pseudostratified columnar epithelium rich in goblet cells.
- contains accessory lacrimal tissue, ductules of the fornix superiorly and laterally
- Lymphoid population is most noticeable in the fornix
- in viral conjunctivitis, lymphoid follicles may enlarge sufficiently to be visualized clinically by slit-lamp examination
- Granulomas-associated with systemic sarcoidosis detected here
- yield of granulomas from biopsy in individuals suspected of sarcoid is as high as 50%.
2
