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WORKSHEET FOR GROSSING EYEBALLS.

Relate all lesions to clockface and A-P location relative to limbus, equator, or posterior pole

PHS # ___________. SS# _______________Pt. Name ________________ specimen label___________

History_________________________________________________________________________________

•Type of specimen: enucleation/evisceration/exenteration (circle).

Identified as right/left eye by the insertion of inferior oblique muscle (absolutely critical for medicolegal issues)

OR •Cannot identify side by inspection (give details on how eye is oriented based on paperwork).

 

•Measurements of globe (in mm)

               AP

               Horizontal

               Vertical

 

•Measurement of cornea (mm)

               Horizontal

               Vertical

               Description (clear, diffusely cloudy, arcus senilis, band keratopathy)

               LOOK FOR penetrating injuries, sutures, particularly around limbus (may need to use dissecting scope) (describe dimension and location by clockface with 12:00 superior as you look at the front of the eye)

 

•Iris - color, defects (locate by clockface with 12:00 superior as you look at the front of the eye)

Pupillary opening - (mm, symmetric or assymetric and displaced towards 4:00 etc.)

 

•Lesions of the scleral surface (hemorrhage, senile plaques, pterygium, scleral buckle)

 

•Optic nerve: segment length (mm)                                 diameter or horizontal/vertical dimensions (mm)

 

•TRANSILLUMINATION - in the dark with bright light source

               Trace lesions onto scleral surface using sharpie. Then measure the maximum extent in two dimensions (usually need to cut eye to get third dimension).

 

•Based upon transillumination and external exam, decide which plane to cut eye.

Usually horizontal is preferred so that macula and optic nerve head can be sampled.

Tumor cases may dictate special decisions for the first cut (e.g. 2:30 to 8:30 instead of 3:00 to 9:00)

 

•Cut eyes on either side of the cornea to make signet ring. If optic nerve segment short, ink it to aid histotechs in identifying when they have cut into it.

 

•Anterior chamber

•Lens (color, position -centered behind pupil, displaced anteriorly, superiorly, etc.)

•Ciliary apparatus (cysts - pars plicata or pars plana)

•Retina, Macula, Optic nerve head

•Sclera ?? Evidence of transcleral extension of tumor??

 

All retinoblastoma cases must have margin of optic nerve inked and submitted as cross section in separate block with tea bags/sponges!!

Otherwise, central ring is sufficient in A1.