GENERAL GUIDELINES FOR GROSSING AND HISTOLOGY OF EYE SPECIMENS.

Revised 1/13/04, C. Chu

 

1. Cornea

               Gross: Measure diameter and height. Look for focal lacerations on surface using dissecting scope. Bisect and submit in mesh casette for embedding on edge. Please do not smash the dome.

 

               Histology Cornea protocol: One H&E and one PAS.

 

2. Intact eyeballs. Should consult with Dr. Chu or Frank Fusca before cutting.

               Gross: Fix for 24 h. See EyeGross WS. References: Spencer 4th Ed, Chapter 1 pp. 1-12 or Apple & Rabb 5th edition, pp. 1-6.

 

               Histology Eyeball Enucleation Protocol:

               Cut at 6 micron thick. Please try to use standard width (2.5 cm) slides if possible.

               Please save 3-7 unstained levels when faced off and on the way to the optic nerve

               One H&E and one PAS from the level of the optic nerve.

 

2. Conjunctival biopsies, especially for nevus vs. melanoma.

               Gross: Treat like a skin biopsy. Measure, try to identify epithelial surface. Measure and note focal lesions. If biopsy >2.5 mm, bisect perpendicular to epithelial surface.

Histology: For nevus vs. melanoma, order 3 H&E levels. For very small biopsies, order 4 blanks. All others, one H&E

 

3. Small specimens such as trabeculectomy, intraocular stuff after trauma.

               Gross: Measure and submit in teabag or between sponges.

               Histology: One H&E. If biopsy is extremely small, please cut 3-5 unstained slides.

 

4. Eviscerations.

               Gross: Describe size of scleral ellipse, measure and describe cornea, measure and describe attached intraocular contents. Submit representative sections. See Frank or Dr. Chu if unsure.

               Histology: One H&E.

 

5. Foreign bodies.

               Gross: Measure, describe, color, hardness, material. Submit any significant attached tissue.

Label and SAVE all foreign bodies indefinitely. They are commonly requested for legal reasons.

WORKSHEET FOR GROSSING EYEBALLS.

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

 

•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)

 

•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.