Lee's Ophthalmic Histopathology

Preface to the Fourth Edition
Preface to the Third Edition
Preface to the Second Edition
Preface to the First Edition
Acknowledgements
Contents
1: Examination of the Globe. Technical Aspects
	Introduction
	Clinical Correlation
		Background Information
		Clinical Techniques for Investigation, Illustration, and Documentation
		Equipment for Macroscopic Examination
	Basic Gross Anatomy: External Features
		Measurement of Ocular Dimensions
		The Anterior Segment
			The Cornea
			The Anterior Ocular Structures
			The Sclera
		The Posterior Aspect
			The Optic Nerve
			The Vortex Veins
			Orientation of the Primary Cuts into the Globe
			Transillumination/Retroillumination
			Vertical Calottes
			Horizontal Calottes
			Oblique Calottes
			The Unfixed Globe
	Basic Gross Anatomy: Internal Features
		Examination of Specific Features
			Cornea
			Anterior Chamber (Fig. 1.11a, b)
			Iridocorneal Angle (Fig. 1.11a, b)
			Iris
			Ciliary Body
				Pars Plicata
				Pars Plana
			Lens
			Vitreous
			Retina
				The Peripheral Retina
				The Posterior Retina
			The Macula
			Optic Disc
			Choroid
			Sclera
			Retrieval of Tissue from the Calottes
			Radiological Examination of the Globe
		Common Artefacts
			Myelin Artefact
			Shrinkage Artefact
			Autopsy Material
	Fixation Techniques
		Formalin-Based Fixatives
			Formaldehyde
			Glutaraldehyde (2–4%)
		Embedding Techniques
			General Considerations
		Histological Examination of a Section of the Globe and Preparation of a Pathological Report
	Specialised Techniques
		Introduction
		Retinal Digest Preparations
		Injection Techniques (Carbon, Plastic)
		Frozen Sections for Fat
		Stains for Microscopy
			Conventional Stains
		Immunohistochemistry
		In Situ Hybridisation (ISH)
		Polymerase Chain Reaction (PCR)
		Tumour Cytogenetics
		Next Generation Sequencing
		Flow Cytometry
	Techniques for Illustration and Documentation
		Photomacrography
		Photomicroscopy and Digital Pathology
			Polarised Light
			Fluorescence Microscopy
			Electron Microscopy
		Diagnostic Cytopathology
		Normal Ocular Histology
	References
2: The Traumatized Eye
	Introduction
	The “Irreparable Eye”
		Large Penetrating or Perforating Wounds of the Corneoscleral Envelope
		Macroscopic Examination
		Microscopic Examination
	The Globe Removed in the Short Term After Attempted Repair
		Reparative Changes in Ocular Tissues
			Fibrous Ingrowth
			Organization of Blood
			Hypotonia
			Retina and Optic Nerve
			Photoreceptor Disintegration
			Lens
			Haemosiderosis Bulbi
	Globe Containing a Metallic Foreign Body
		Macroscopic Examination
		Types and Effects of Metallic Foreign Bodies
		Siderosis
		Chalcosis
	Long-Term Effects of Ocular Trauma
		Macroscopic Examination
		Post-traumatic Glaucoma
			Secondary Angle Closure
			Secondary Open Angle Glaucoma
				Angle Recession
				Epithelial Downgrowth
		Lens Abnormalities
			Lens Dislocation
			Lens-Induced Uveitis
		Post-traumatic Retinal Changes
			Haemorrhage and Traumatic Detachment
		Post-traumatic Pseudoretinitis Pigmentosa
	Sympathetic Ophthalmitis
		Macroscopic Examination
		Microscopic Examination
	Post-traumatic Phthisis
		General
		Cyclitic Membrane
		Lens in Phthisis Bulbi
		Retinal Gliosis
		Retinal Pigment Epithelium in Phthisis Bulbi
		Choroid in Phthisis Bulbi
		Optic Nerve in Phthisis Bulbi
	Hot Metals, Acids, and Alkalis
	Effects of Ionizing Radiation
	The Infant Eye in Abusive Head Trauma
	References
3: Absolute Glaucoma
	Introduction
	The Functional Morphology of the Outflow System
		Aqueous Inflow
		Aqueous Outflow
			The Trabecular Meshwork
			The Canal of Schlemm
	Classification of Glaucoma
		Primary Open Angle Glaucomas (POAG)
			Normal Tension Glaucoma (NTG)
		Primary Acute Angle Closure Glaucoma
		Primary Congenital Forms/Childhood Glaucomas
		Secondary Glaucomas
	Primary Open Angle Glaucoma
		Treatment of Primary Open Angle Glaucoma
		Surgical Trabeculectomy
		Pathological Features
		Laser Treatment
		“Low Tension” Glaucoma
	Primary Acute Angle Closure Glaucoma
		Clinical Features and Pathogenesis
		Chronic Angle Closure Glaucoma
		Iridectomy Specimen
		Trabeculectomy Specimens
		Unsatisfactory Response to Treatment
	Congenital Glaucoma: Buphthalmos
		Goniodysgenesis
		The Phakomatoses
	Secondary Open Angle Glaucoma
		Introduction
		Iatrogenic Glaucoma
			Steroid-Induced Glaucoma
			Silicone Oil
			Viscoelastic Substances
		Melanotic Glaucoma
			Introduction
			Pigmentary Glaucoma
			Melanomalytic Glaucoma
		Blood Products (Haemolytic Glaucoma)
		Lens Protein Glaucoma
			Phacolytic Glaucoma
		Glaucoma in the Exfoliation Syndrome (ES/PEX/PXS)
			Post-traumatic Glaucoma
			Schwartz-Matsuo Syndrome
		Glaucoma Associated with Tumours
			Malignant Tumours
		Iris Naevus Syndrome
			The Cogan-Reese Syndrome
			Juvenile Xanthogranuloma
			Mucogenic Glaucoma
	Secondary Angle Closure Glaucoma
		Neovascular Glaucoma
		Inflammatory Disease
		Retinal Detachment
		Tumours
		Trauma
		Malignant Glaucoma
		Iridocorneal-Endothelial (ICE) Syndrome
	Tissue Effects of Glaucoma
		Acute Glaucoma
			Cornea
			Iris
			Lens
			Retina and Optic Nerve
		Tissue Changes in Long-Standing Glaucoma
			Cornea
			Chamber Angle
				Endothelial Downgrowth
				Outflow System
			Iris
			Ciliary Body
			Lens
			Vitreous
			Retina
			Optic Disc and Optic Nerve
				The Pathogenesis of Glaucomatous Optic Atrophy
		Choroid
		Corneoscleral Envelope
		Evolution of End-Stage Pathology
	Complications in the Surgical Treatment of Glaucoma
		Trabeculectomy
		Ciliary Body Surgery: Cyclodestructive processes
		Other Cyclodestructive Techniques
		Laser Trabeculoplasty
		Glaucoma Drainage Device
		Retrobulbar Alcohol
	References
4: Retinal Vascular Disease
	Introduction
	Retinal Ischaemic Disease
		Pathogenesis of Retinal Ischaemia
		Characteristic Pathological Features of Focal Ischaemic Retinal Disease
			Microinfarction or “Cotton Wool Spots”
			Exudation of Plasma or “Hard” Exudates
			Haemorrhage
			Microaneurysms
			Neovascularisation
				Clinical Relevance (Fig. 4.9)
				Macroscopic Features of the Enucleated Globe
				Microscopic Features
				Arteriolosclerosis and Venulosclerosis
	Common Disease Entities Associated with Intraocular Neovascularisation
		Retinal Vein Occlusion (RVO)
		Central Retinal Vein Occlusion (CRVO)
			Pathogenesis of Central Vein Occlusion
			Additional Features
		Branch Vein Occlusion
		Diabetes
			Clinical Background
			Macroscopic Examination
			Microscopic Examination
			Pathogenesis and Effects of Treatment in Proliferative Diabetic Retinopathy
		Recent Advances
	Rarer Vascular Disorders Leading to Neovascular Glaucoma
		Coats’ Disease
			Macroscopic Examination
			Microscopic Examination
			Coats’ Reaction, Coats’ Response or Coats’ Syndrome
			Idiopathic Juxtafoveolar Retinal Telangiectasis
		Retinopathy of Prematurity
		Haemoglobinopathies
		Radiation Retinopathy
		Norrie Disease
	Vascular Disorders That Rarely Lead to Neovascular Glaucoma in Adults
		Central Retinal Artery Occlusion
		Posterior Ciliary Artery Occlusion
		Ophthalmic Artery Occlusion
		Hypertension
		Disseminated Intravascular Coagulopathy (DIC)
	Choroidal Neovascularisation and Age-Related Macular Degeneration (ARMD)
		Choroidal Neovascularisation
		Age-Related Macular Degeneration (ARMD)
		Disciform Degeneration
			Excised Submacular Membranes
		Inflammatory Disease Associated with Neovascularisation
	References
5: Intraocular Tumours
	Introduction
	Melanocytic Tumours
		Introduction
		Benign Melanocytic Tumours (Naevi)
			Incidence
			Iris Naevus
			Iris Naevus Syndrome
			Ciliary Body Naevi
			Ciliary Body Melanocytoma (Magnocellular Naevus)
			Choroidal Naevus
			Bilateral Diffuse Uveal Melanocytic Hyperplasia
			Dysplastic Naevus Syndrome
		Rare Benign Melanocytic Proliferation
			Ocular Melanocytosis
			Melanocytomas of the Optic Nerve Head
	Malignant Melanoma of the Uveal Tract
		Malignant Melanoma of Iris
			Clinical and Macroscopic Aspects
			Histopathology of Iris Melanoma
		Malignant Melanoma of the Ciliary Body and Choroid
			Clinical Aspects
			Pathological Features of Ciliary Body and Choroidal Melanoma
				Transillumination and Orientation
			Macroscopic Appearances of Ciliary Body and Choroidal Melanomas
			Extrascleral Spread
			Optic Nerve Extension
		Cavitary Melanoma
			Microscopic Features
			Tumour Cell Morphology
			Spindle Cell Type Variants
			Epithelioid Cells
			Mixed Cell Type
			PAS Positive Patterns
	Melanin Content, Inflammatory Cell Infiltration, Proliferation and Mitotic Activity
	Pathological Factors Indicating a Poor Prognosis
		Genetic Abnormalities
	Management of Uveal Melanoma
		Pathological Management of Specimens for Ciliary Body and Choroidal Melanoma
			Iridocyclectomy
			Choroidectomy
			Exoresection (Transcleral Resection)
			Endoresection (Transretinal Resection)
		Ionising Radiation in the Treatment of Uveal Melanomas
		Brachytherapy
		Proton Beam Radiotherapy
		Light and Heat Effects on Uveal Melanomas
		Trans-Pupillary Thermotherapy (TTT)
	Other Iris Tumours
		Spindle Cell Tumours
		Histiocytic Tumours
		Adenomas
		Cysts
		Metastatic Tumours
	Other Tumours of the Ciliary Body
		Spindle Cell Tumours
		Tumours of the Epithelium of the Ciliary Processes and the Pars Plana
			Adenomas/Adenocarcinomas
			Medulloepithelioma
	Other Tumours of the Choroid
		Metastatic Tumours
		Choroidal Lymphoma and Leukaemia
		Vascular Tumours
		Choroidal Osteoma
	Tumours of the Retinal Pigment Epithelium (RPE)
		Adenomas and Adenocarcinomas of the RPE
		Reactive Hyperplasia of the RPE
		Congenital Hypertrophy of the RPE (CHRPE)
		Simple and Combined Hamartoma of the RPE
	Non-neoplastic Lesions Simulating Malignant Melanoma
		Uveal Effusion Syndrome
		Choroidal Haemorrhage
		Retinal Macrocyst
	Tumours of the Retina
		Primary Vitreo-Retinal Lymphoma (PVRL)
		Differential Diagnoses
		Treatment
	Retinoblastoma
		Introduction
		Genetic Features
		Clinical Features
		Pathological Features of Retinoblastoma
			Macroscopic Examination
			Danger of Artefact
			External Examination
			Tumour Appearances
		Clinical Effects of Irradiation
			Microscopic Features
			Differentiation within Retinoblastoma
			Microscopic Effects of Irradiation
		Hazards in the Histological Assessment of Retinoblastoma
		Prognostic Indicators
	Tumours That May Simulate Retinoblastoma
		Retinocytoma
		Nodular and Massive Retinal Gliosis
		Astrocytic Hamartoma
		Miscellaneous
	Tumours Metastasising to the Retina
	Non-Neoplastic Lesions That Mimic Retinoblastoma
	References
6: Ocular Inflammation
	Introduction
	The Anatomy of the Eye in Relation to Infective Processes
	Pyogenic Bacterial Infections
		Introduction
		Corneal Ulceration
		Acute Bacterial Pyogenic Endophthalmitis
		Common and Rare Pathogenic Bacteria
		Macroscopic Features
		Microscopic Features
		The Evisceration Specimen
		Implants
	Fungal Infection
	Viral Infection
		Introduction
		Measles (Rubeola)
		Rubella (German Measles)
		Acute Retinal Necrosis (ARN) Syndrome
		Cytomegalovirus
		Retinal Biopsy
		Acquired Immunodeficiency Syndrome (AIDS)
		Herpes Zoster
	Chronic Specific Granulomatous Inflammation
		Introduction
		Tuberculosis
		Sarcoidosis
		Syphilis
		Rheumatoid Eye Disease: “Scleritis” and “Sclerokeratitis”
		Scleritis: Causes Other than Autoimmune Disease
			Infectious Scleritis
			Surgically Induced Necrotising Scleritis (SINS)
			Risedronate Associated Scleritis
			Irradiation Scleritis
			IgG4 RD Scleritis
			Masquerade Scleritis
		Protozoal Disease: Toxoplasmosis and Malaria
		Ocular Toxocariasis
		Chronic Uveitis
		HLA B27 Associated Uveitis
		Behçet’s Disease
		Vogt-Koyanagi-Harada Syndrome (VKH)
		Fuchs Heterochromic Cyclitis
		White Dot Syndromes (WDS)
	References
7: Treatment of Retinal Detachment
	Introduction
	Classification of Retinal Detachment
		Rhegmatogenous Detachment
		Exudative Detachment
			Central Serous Chorioretinopathy
		Tractional Detachment
	Degenerative and Other Conditions That Predispose to Retinal Detachment
		Lattice Degeneration
			Retinal Holes and Tears
		Peripheral Microcystoid Degeneration
		Vitreomacular Disease
			Posterior Vitreous Detachment (PVD)
			Vitreomacular Adhesion (VMA)
			Vitreomacular Traction (VMT)
			Lamellar Macular Hole (LMH)
			Impending Macular Hole (IMH)
			Full-thickness Macular Hole (FTMH)
			Macular Pseudohole
			Inherited Vitreoretinopathy
		Hereditary Progressive Arthro-Ophthalmopathy (Stickler Syndrome)
	Innocuous Peripheral Retinal Disease
		Paving Stone or Cobblestone Degeneration
		Lipoidal Degenerations
		Meridional Folds
		Retinal Tissue Rarefaction
		Pigmentation
		Retinoschisis
		Peripheral Reticular Degeneration
		Myopia
	Effects of Detachment on the Ocular Tissues
		Introduction
		Changes in the Neural Retina
		Changes in the Retinal Pigment Epithelium
		Secondary Effects in the Vitreous
		Effects on Lens
	Pathology of Treatment of Retinal Detachment
		Buckling or Scleral Indentation
		Cryotherapy or Laser Photocoagulation
		Replacement of Vitreous
		Intraocular Silicone Oil
		Sulphur Hexafluoride (SF6)
		Heavy Liquids
		Retinal Tacks
		Retinotomy and Retinectomy
		Human Amniotic Membrane Plug
		Vitrectomy Procedure
		Vitrectomy Specimens and Epiretinal Membranes
	Retinal Detachment and Reattachment
		Retinal Displacement Without Detachment
		The Extruded Silicone Sponge or Plomb
		Asteroid Hyalosis
	References
8: The Malformed Eye
	Introduction
	Relevant Basic Ocular Embryology
	Gross Malformations Due to Abnormal Development in the First 4 Weeks of Embryonic Life
		Malformation of the Optic Vesicle
			Anophthalmia
			Nanophthalmia and Microphthalmia
			Synophthalmia and Cyclopia
		Malformation of Optic Cup: Closure of Optic Fissure
			Congenital Cystic Eye
			Coloboma
			Colobomatous Cysts
			Amniotic Band Syndrome
		Malformations of the Anterior Segment
			Cornea and Chamber Angle
			Lenticulocorneal Fusion
		Corneal Malformation
			Peters Anomaly
			Sclerocornea
			Megalocornea
			Axenfeld-Rieger Syndrome
			Fetal Alcohol Syndrome
		Chamber Angle Malformation or Goniodysgenesis
			Aniridia
		Malformation of Lens
		Malformations of the Vitreous and Hyaloid Artery System
			Pure Anterior Persistent Fetal Vasculature (Anterior PFV)
			Pure Posterior Persistent Fetal Vasculature (Posterior PFV)
			Combined Persistent Fetal Vasculature (Combined PFV)
		Malformations of the Retina
		Malformations of the Optic Nerve Head
			Colobomata and Optic Disc Pits
			Axial Coloboma or “Morning Glory Disc Anomaly”
			Lipomatosis of the Optic Nerve
			Myelinated Nerve Fibres
	The Phakomatoses
		Definition
		Neurofibromatosis
			Neurofibromatosis Type 1 (Von Recklinghausen’s Disease)
			Neurofibromatosis Type 2 (Central Neurofibromatosis)
		Tuberous Sclerosis (Bourneville’s Disease)
		von Hippel-Lindau Disease
			Sturge-Weber Syndrome (Encephalotrigeminal Angiomatosis)
	Syndromes Associated with Chromosomal Abnormalities
		Introduction
		Trisomy 13 (Patau Syndrome)
		Trisomy 18 (Edwards Syndrome)
		Trisomy 21 (Down Syndrome)
	References
9: “Autopsy Eye”: The Eye in Systemic Disease
	Introduction
	Methods for Obtaining Ocular Tissue at Autopsy
		Donated Material
		Anterior Enucleation Technique
		Removal of the Posterior Part of the Globe
		Removal of the Globe and Orbital Contents
		Value of Autopsy Material in Ophthalmology
	Vascular Disease
		Introduction: Ischaemic Ocular Disease
			Malignant Hypertension
			Collagen Vascular Diseases
			Temporal Arteritis
			Non-arteritic Optic Neuropathy: Anterior Ischaemic Optic Neuropathy (AION)
			Subarachnoid Haemorrhage
			Choroideraemia
	Haematological Disorders
		Leukaemia and Lymphoma
		Anaemia and Thrombocytopenia
		Macroglobulinaemia
		Disseminated Intravascular Coagulopathy (DIC)
		Langerhan’s Cell Histiocytosis
	Degenerative Disease
		Myopia
		Angioid Streaks
	Tapetoretinal Degeneration
		Introduction
		The Anatomy of the Photoreceptors
		The Anatomy of the Retinal Pigment Epithelium
		Interrelationship Between the Retinal Pigment Epithelium and the Photoreceptors
		Importance of Vitamins A and E
		Retinitis Pigmentosa
		The Ciliopathies
			Usher Syndrome
			Leber’s Congenital Amaurosis
		Sorsby’s Fundus Dystrophy
	Metabolic Deficiencies Associated with Pigmentary Retinopathy
		Lysosomal Disorders
			Mucopolysaccharidoses
			Fucosidosis
			Neuronal Ceroid Lipofuscinosis (NCL)
			Cystinosis
		Peroxisomal Disorders
			Zellweger Spectrum Disorders
			Adult Refsum’s Disease
			Hyperoxaluria
		Homocystinuria
		Myotonic Dystrophy (Type 1)
		Mitochondrial Diseases
			Kearns-Sayre Syndrome (KSS)
			MELAS Syndrome
			Leigh Syndrome
			Leber’s Hereditary Optic Neuropathy
			Gyrate Atrophy
		Disorders of Sphingolipid Metabolism
			GM 2 Gangliosidosis (Types I, II, and III)
			Tay-Sachs Disease (GM2-Gangliosidosis Type 1)
		Association with Gastrointestinal and Hepatic Disease
			Familial Adenomatous Polyposis (Gardner Syndrome)
			Alagille Syndrome (Arteriohepatic Dysplasia)
	Pigment Epitheliopathies Limited to the Macula
		Best Vitelliform Macular Dystrophy
		Stargardt Disease and Fundus Flavimaculatus
	Lipofuscin in the Retinal Pigment Epithelium
	Neurological Disorders
		Papilloedema
		Drusen of the Optic Disc
	Immune Mediated Diseases
		Multiple Sclerosis
		The Empty Sella Syndrome
		Paraneoplastic Syndromes
		Wolfram Syndrome (DIDMOAD)
	Deficiency Diseases
		Nutritional Amblyopia: Tobacco Alcohol Amblyopia
	Other Systemic Metabolic Diseases
		Albinism
		Marfan’s Syndrome
	Toxicity
		Toxic Compounds
		Therapeutic Agents
			Tamoxifen Retinopathy
			Chloroquine
			Phenothiazines
			Methyoxyfluorane
			Amiodarone
	References
10: Biopsy of the Eyelid, the Lacrimal Sac, and the Temporal Artery
	Introduction
		Relevant Functional Anatomy of the Eyelid
		Surgical Anatomy and Surgical Pathology
		Incidence of Various Types of Eyelid Pathology
	Eyelid Cysts: “Excision of Subcutaneous Nodule”
		Epidermal Cysts
		Intratarsal Keratinous Cysts
		Sweat Gland Cysts
		Meibomian Cyst: Chalazion
	Benign Epithelial Tumours
		Basal Cell Papilloma and Squamous Cell Papilloma
		Inverted Follicular Keratosis
		Keratoacanthoma
		Viral Wart
		Molluscum Contagiosum
	Other Benign Adnexal Tumours
		Adnexal Tumours with Follicular Differentiation
		Adnexal Tumours with Sweat Gland Differentiation
		Adnexal Tumours with Sebaceous Differentiation
	Naevi
		Junctional Naevus
		Compound and Intradermal Naevi
		Rare Benign Melanocytic Tumours
			Spitz Naevus
			Blue Naevus
			Oculodermal Melanocytosis (Naevus of Ota)
	Malignant Epithelial Tumours
		Premalignant Change
			Actinic, Solar, or Senile Keratosis
			Bowen’s Disease
		Basal Cell Carcinoma (BCC)
		Squamous Cell Carcinoma
		Sebaceous Carcinoma
		Merkel Cell Carcinoma
		Other Malignant Adnexal Tumours
			Microcystic Adnexal Carcinoma
			Endocrine Mucin Producing Sweat Gland Carcinoma
			Signet Ring Cell Carcinoma
	Staging of Eyelid Carcinoma
	Malignant Melanoma
	Metastatic Tumours
		Irradiation Effects
	Some Unusual Disorders in the Eyelid
		Bacterial and Metazoal Infections
		Ligneous Conjunctivitis
		Amyloidosis
		Focal Mucinosis/Calcinosis
		Floppy Eyelid Syndrome
		Melkersson-Rosenthal Syndrome
		Lipoid Proteinosis
	Solid Nodules and Plaques
		Xanthelasma
	Hamartomas and Choristomas
		Angiomas and Lymphangiomas
		Calibre-Persistent Artery
		Encephalocele
		Phakomatous Choristoma
	Miscellaneous Tumours
		Juvenile Xanthogranuloma
		Langerhan’s Cell Histiocytosis
		Epithelioid Haemangioma (Angiolymphoid Hyperplasia with Eosinophilia)
		Granular Cell Tumour
		Neural Tumours
	Lacrimal Sac
		Functional Anatomy
		Inflammatory Disease
			Non-granulomatous Inflammation
			Dacryolith
		Lacrimal Sac Tumours
	Temporal Artery Biopsy
	References
11: The Conjunctival Biopsy
	Functional Anatomy
		Surface Epithelium
		Stroma
		Conjunctival Immunity
		Medial Canthus
		Tear Film
			Keratoconjunctivitis Sicca
	Biopsy Technique
		Practical Aspects
		“Conjunctival Scrapings”
			Bacterial Infection
			Viral Infection
			Chlamydial Infection
			Allergy and Foreign Body
		Impression Cytology
	Inflammatory Disease: Diffuse
		Bacterial Infection
		Lyme Disease
		Bacillary Angiomatosis
		Atopic Keratoconjunctivitis (AKC): Papillary Conjunctivitis
		Contact Lens Wear
		Viral Infections (Follicular Conjunctivitis)
		Adenoviral Infections
		Molluscum Contagiosum
		Chlamydial Infections
			Chlamydiaceae
			Trachoma
			Inclusion Conjunctivitis
			Sarcoidosis
		Fungal Infection
		Parasitic Infection
		Foreign Material
			Mascara
			Other Foreign Materials and Compounds
			Conjunctivitis Artefacta
	Inflammatory Disease: Localised
		Episcleritis
		Phlycten
		Allergic Granulomatous Nodule
		Ophthalmia Nodosa
		Periocular Granuloma Annulare
		Idiopathic Conjunctival Granulomas
		Specific Foreign Body Granulomas
			Stitch Granuloma
			Golf Ball Granuloma
			Synthetic Fibre Granuloma
		Amyloid
		Ligneous Conjunctivitis
	Bullous Disease and Cicatrising Conjunctivitis
		Ocular Cicatricial Pemphigoid (OCP)
		Stevens-Johnson Syndrome
		Acne Rosacea
		Systemic Lupus Erythematosus
		Lichen Planus
		Symblepharon: Reconstructive Surgery
	Non-neoplastic Tumour-Like Lesions of the Conjunctiva
		Cysts
		Reactive Epithelial Hyperplasia
		Pseudoglandular and Pseudoepitheliomatous Hyperplasia
		Pterygium and Pinguecula
		Pseudopterygia (Hypertrophic Conjunctival Scar)
		Actinic Granuloma
	Hamartomatous and Choristomatous Tumours
		Intrascleral Nerve Loop and Neural Tumours
		Haemangiomas
		Lymphangiectasis and Lymphangioma
		Epibulbar Dermoid, Dermolipoma and Complex Choristoma
		Epibulbar Osteoma/Osseous Choristoma
		Prolapsed Fat
	Benign, Premalignant, and Malignant Tumours of Epithelium
		Pedunculated Papillomas
		Placoid or Sessile Papillomas
		Conjunctival Squamous Intraepithelial Neoplasia [Conjunctival Intraepithelial Neoplasia (CIN) and Carcinoma In Situ (CIS)]
		Squamous Cell Carcinoma
		Spindle Cell Carcinoma
		Hereditary Benign Intraepithelial Dyskeratosis of the Conjunctiva
		Intraepithelial Sebaceous Carcinoma
	Melanocytic Tumours
		Naevi
		Junctional Naevi
		Compound and Intrastromal/Subepithelial Naevi
		Inflamed Juvenile Conjunctival Naevi
		Spitz Naevi
		Blue Naevi
		Balloon Cell Naevi
		Benign Acquired Melanosis/Benign Epithelial Melanosis of the Conjunctiva
		Conjunctival Melanocytic Intraepithelial Neoplasia (C-MIN)/Primary Acquired Melanosis (PAM)
		Primary Acquired Melanosis Without Atypia/C-MIN Score = 1
		Primary Acquired Melanosis with Atypia/C-MIN Score = 2–5
	Conjunctival Melanoma
	Lymphoid Proliferations
		Reactive Lymphoid Hyperplasia
		Malignant Lymphoma
		Sinus Histiocytosis (Rosai-Dorfman Disease)
	Miscellaneous Soft Tissue Tumours of Conjunctiva and Caruncle
		Haemangiomas
		Kaposi’s Sarcoma
		Angiosarcoma
		Fibrous Histiocytoma and Related Entities
		Myxoma
		Conjunctival Stromal Tumour
		Juvenile Xanthogranuloma
		Leiomyosarcoma
		Rhabdomyosarcoma
		Neurofibroma
		Schwannoma
	Secondary Tumours of the Conjunctiva
	Other Tumours of the Caruncle
		Naevus
		Sebaceous Adenoma
		Sebaceous Carcinoma
		Oncocytoma
	References
12: The Orbit: Biopsy, Excision Biopsy, and Exenteration Specimens
	Introduction
	Clinicopathologic Background
	Orbital Cysts
		Simple Cysts
		Haematic Cyst
		Mucocele
		Dermoid Cysts
		Enterogenous Cyst
	Idiopathic Orbital Inflammatory Disease
		Orbital Apical Syndrome (Tolosa-Hunt Syndrome)
		Idiopathic Sclerosing Inflammation of the Orbit
		Multifocal Fibrosclerosis
		IgG4 Related Disease (IgG4RD)
	Inflammation in Extraocular Muscle and Optic Nerve
		Endocrine Exophthalmos: Thyroid Associated Ophthalmopathy
		Orbital Myositis
	Specific Inflammatory Disease
		Bacterial Infection: Orbital Cellulitis
		Fungal Infection
			Aspergillosis
			Mucormycosis
		Parasitic Infection
			Sarcoidosis
			Amyloidosis
		Granulomatosis with Polyangiitis (Formerly Wegener’s Granulomatosis)
	Tumours of the Orbit
		Lymphoid Tumours
			Benign Lymphoid Hyperplasia
			Lymphoma
			Extra-Nodal Marginal Zone Lymphoma (EMZL)
			Diffuse Large B Cell Lymphoma
			Follicular Lymphoma
			Other B Cell Lymphomas
			T-Cell Lymphomas
			Hodgkin Disease
			Plasma Cell Neoplasms
			Other Haematological Neoplasms
		Vascular Lesions
			Vascular Hamartomas
			Epithelioid Haemangioma (Angiolymphoid Hyperplasia with Eosinophilia)
			Lymphangioma
			Other Vascular Lesions
			Malignant Vascular Tumours
		Fibroblastic Tumours
			Solitary Fibrous Tumour
		Myogenic Tumours
			Rhabdomyosarcoma
		Adipocytic Tumours
			Lipomas
			Liposarcoma
			Atypical Lipomatous Tumour (ALT)
			Myxoid Liposarcoma
		Neural Tumours
			Neurofibroma
			Schwannoma
			Malignant Peripheral Nerve Sheath Tumour
			Olfactory Neuroblastoma
		Other Soft Tissue Tumours
			Granular Cell (Myoblastoma) Tumour
			Alveolar Soft Part Sarcoma
			Epithelioid Sarcoma of the Orbit
			Other Soft Tissue Tumours
		Miscellaneous Tumours and Tumour-Like Conditions
			Orbital Teratoma
			Sinus Histiocytosis with Massive Lymphadenopathy
			Orbital Xanthogranulomatous Disease
			Juvenile Xanthogranuloma
			Nodular Fasciitis
			Tumours of the Bony Orbit
			Orbital Osteoma
			Osteosarcoma
			Ewing Sarcoma
			Fibroosseous Lesions
			Aneurysmal Bone Cyst
			Langerhans Cell Histiocytosis (Eosinophil Granuloma)
	Disorders of the Optic Nerve
		Benign Intracranial Hypertension (Pseudotumour Cerebri)
		Primary Tumours of the Optic Nerve
		Meningiomas of the Optic Nerve
	Lacrimal Gland Tumours
		Normal Anatomy
		Inflammatory Conditions of the Lacrimal Gland
			Sarcoidosis
			Necrotizing Sialometaplasia
			Sjögren Syndrome and Mikulicz Disease
		Non-epithelial Tumours
		Epithelial Tumours
			Dacryops
			Pleomorphic Adenoma
			Pleomorphic Carcinoma (Malignant Mixed Tumour)
			Adenoid Cystic Carcinoma
			Mucoepidermoid Carcinoma
			Other
			Lymphoma
		Secondary and Metastatic Tumours in the Orbit
			Metastatic Tumours
			Endocrine Exophthalmos/Thyroid-Associated Ophthalmopathy
	The Exenteration Specimen
		Orbital Implant
	References
13: The Corneal Disc
	Introduction
	Relevant Functional Anatomy
	Corneal Transparency
	Background: Clinical Aspects of Keratoplasty
	Macroscopic Examination of the Excised Cornea Disc
	Non-specific Changes in a Keratoplasty Specimen
		Epithelial Reactions
		Anterior Fibrosis/Pannus
		Refractive Eye Surgery
			Radial Keratotomy
			Photorefractive Keratectomy (PRK)
			Laser-Assisted In Situ Keratomileusis (LASIK)
			Laser-Assisted Subepithelial Keratectomy
			Corneal Inlays and Onlays
		Deposition of Extracellular Material
		Stromal Abnormalities
		Descemet’s Membrane and Endothelium
		Common Disorders Treated by Keratoplasty
		Post-aphakic Decompensation: Pseudophakic Bullous Keratopathy
			General Considerations
			Pathological Features of Endothelial Decompensation
	Keratoconus
		General Considerations
		Macroscopic Examination
		Microscopic Features
	Keratoglobus
	Herpes Simplex (HSV) Keratitis
		Pathogenesis
		Macroscopic Examination
		Microscopic Features
	Other Viral Infections
		Rheumatoid Ulceration and Vasculitic Keratitis
			Mooren’s Ulcer and Terrien’s Marginal Degeneration
	Repeat Keratoplasty
		General Considerations
		Pathological Features of Graft Rejection
	Corneal Ulceration
		General
		Corneal Scrapings
		Pathology of the Ulcerated Cornea
		Emergency Treatment of a Corneal Ulcer
	Uncommon Corneal Infections
		Bacterial “Crystalline” Keratopathy
		Acanthamoeba Keratitis
	Exotic Organisms
	Specific Forms of Keratitis
		Interstitial Keratitis
		Rosacea Keratitis
		Vernal Plaque
		Aniridia Keratopathy
		Recurrent Erosions
		Salzmann’s Nodular Degeneration
	Corneal Dystrophies
		General Considerations
		Epithelial and Subepithelial Corneal Dystrophies
			Epithelial Basement Membrane Dystrophy (EBMD)
			Meesmann’s Dystrophy
			Lisch Epithelial Dystrophy
			Gelatinous Drop-Like Corneal Dystrophy (Subepithelial Amyloidosis)
		Epithelial-Stromal TGFBI Dystrophies
			Reis-Bückler Dystrophy
			Thiel-Behnke Dystrophy
			Lattice Corneal Dystrophy (Type 1)
			Granular Corneal Dystrophy (Type 1 Classic)
			Granular Corneal Dsytrophy (Type 2)
		Stromal Dystrophies
			Macular Corneal Dystrophy
			Schnyder Corneal Dystrophy
		Endothelial Dystrophies
			Fuchs’ Endothelial Dystrophy
		Posterior Polymorphous Corneal Dystrophy (PPCD)
		Congenital Hereditary Endothelial Dystrophy (CHED)
		X-linked Endothelial Dystrophy (XECD)
		Other Endothelial Abnormalities
			The Iridocorneal Endothelial Syndrome (ICE Syndrome)
	Deposition of Exogenous Materials
		Calcium
		Pigmentation
		Corneal “Gammopathy”
		Climatic Droplet Keratopathy
		Silicone Oil Keratopathy
		Trauma
			Chemical Burns
	Damage by Heat and Irradiation
		Developmental Abnormalities
	Corneal Hamartomas: Dermoid
	Corneal Tumours
	Miscellaneous Disorders of the Cornea
		Mucopolysaccharidoses
		Climatic Proteoglycan Stromal Keratopathy
		Lipofuscinosis of the Cornea
		Familial LCAT Deficiency: Fish Eye Disease (FED)
	References
14: Lens
	Introduction
	Part 1: The Normal Lens
	Part 2: Cataract
		Congenital Cataract
			Absence or Deformation of the Lens
		Some Important Disease Entities Associated with Cataract
			Rubella Cataract
			Marfan’s Syndrome
			Homocystinuria
			Lowe’s (Oculocerebral) Syndrome
			Galactosaemia
			Myotonic Dystrophy
			Uncombable Hair Syndrome
		Non-specific Degenerative Changes in the Lens Substance
			Introduction
			Cortical Abnormalities
			Nuclear Abnormalities: Pigmentation (or Brunescent Cataract)
			Lens Epithelial Abnormalities
				“Glaucomflecken”
				Metaplasia
		Traumatic Cataract
			Civil Trauma
			Indirect Surgical Trauma
		Irradiation Cataract
		Microwave
		Infrared Cataract
	Part 3: Surgical Techniques in the Treatment of Cataract
		Introduction
		Intracapsular Cataract Extraction (ICCE)
		Extracapsular Cataract Extraction (ECCE)
		Phacoemulsification
		Femtosecond Laser-Assisted Cataract Surgery (FLAC)
		Nanosecond Laser Cataract Surgery
		Intraocular Lens Implants
		Anterior Chamber Lens Implants
		Posterior Chamber Lens Implants
		Complications of Phacoemulsification
	Part 4: Pathology of the Enucleated Eye After Lens Extraction
		Soemmering’s Ring (Donut) Cataract
		Peripupillary Fibrosis
		Cornea
		Iris
		Aphakic Maculopathy: Cystoid Macular Oedema (CME)
		Epiretinal Membrane Formation
		Effects on the Retinal Photoreceptors
		Vitreous Prolapse/Vitreocorneal Contact/Malignant Glaucoma
		Expulsive Haemorrhage
		Retinal Detachment
		Endophthalmitis
			Acute Infection
			Chronic Inflammation
	References
Index