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Review of pathology slides
- 1. Review of Pathology Slides Dr. Walters
Editor's Notes
- Iris Transillumination
- Oculocutaneous Albinism Decreased VA~20/100 or less Nystagmus, photophobia, no fundus pigment, light irides that transilluminate, lack foveal reflex, absence of pigment in skin and hair
- Ocular Albinism X-linked recessive-affects males, nystagmus, photophobia, reduced VA(20/70-20/200), absence of retinal pigment, iris transillumination, normal pig of skin and hair Normal color vision, normal ERG, hypoplastic fovea
- Albinoidism AD; Normal pigment in skin and hair, lack of reduced VA, hypopigmentation of the iris and fundus, iris transillumination, photophobia, myopia, normal foveal reflex No nystagmus
- Rod Monochromatism Reduced acuity, photophobia, nystagmus, normal pigmented fundus, CV problem, no photopic ERG Reduced peripheral fields, a small central scotoma, and strabismus
- Schubert Bornschein stationary nyctalopia X-linked recessive, or AR Negative ERG, high myopia, nystagmus, strabismus, paradoxical pupillary response Blond fundus & pale disc
- Pavingstone ~25% of eyes, bilateral, RPE dropout Pigmented borders, inferior temporal or inferior nasal
- Lattice Degeneration that is crisscrossed by sclerotic vessles, may be associated with holes or tears, 10% of pop, circumferentially oriented
- White without Pressure Scalloped borders, myopes, elderly and blacks
- Retinoschisis veil-like translucent, absolute VF defect, normal VA, inferior temporal, usually bilateral, non-progressive, no demarcation line, usually peripheral, stationary with eye movements
- Snailtrack Degeneration that is crisscrossed by sclerotic vessels, may be associated with holes or tears, 7% of pop
- Retinal detachment Undulates with eye movements, opaque, relative VF defect, may be bilateral but usually not simultaneous, may involve macula, superior, progressive, demarc line
- Candlewax drippings – Sarcoidosis; Noncaseating granulomas scatttered throughout the body, primarily in the lungs; More common in back females, granulomatous uveitis, dry eyes Koeppe on pupillary margin Busacca within iris stroma
- Band keratopathy –JRA Anterior/non-granulomatous uveitis, young females, fever
- Histoplasmosis Fungus, Mississippi Valley, peripheral atrohpic spots (white punched out lesions with pigment in the middle), peripappilary scarring , maculkopthay caused by subretinal choroidal neo, no visual complaints; Asymptomatic and benign, “presumed”, flu-like symptoms during active period
- Ocular Histoplasmosis Peripapillary atrophy
- Toxoplasmosis; “headlights in fog”, Convulsions, calcification, chorioretinitis Cat, transplacental, majority are congenital, bilateral, posterior granulomatous uveitis, vascular sheathing, white lesions surrounded by pigment Acuities depend on location of chorioretinits BIGGER
- Toxocara From dog-roundworm, usually unilateral, white scar-tissue-no pigment ELISA, non-progressive decreased VA
- CMV Retinitis Ketchup and mayonnaise, cotton wool spots, immunocompromised pt, herpes virus
- Congenital Amaurosis of Leber; Severely reduced VA with normal appearing fundus, sluggish pupils, nystagmus, pale ONH, onset at birth, flat/minimal ERG Nystagmus, photophobia, digito-ocular maneuver, strab, CATs, mental retardation, deafness, renal anomalies seizures, focal neurological deficits EF, salt n’ pepper appearance, bull’s eye appearance; R/O Cortical blindness
- Serpinginous Choroiditis White dot syndrome, sudden painless decrease VA in one or both eyes, pt may notice blind gaps in the VF (scotoma) or a sensation of flashes of light (photopsia) No reduced VA
- Choroidal Scarring due to Trauma Radial tearing, hemorrhages
- Diabetic Retinopathy NPDR/PDR
- Hypertensive Retinopathy Macular edema, no neo of the disc, macular star, AV nicking, Arteriolar narrowing
- Branch Vein Occlusion Hemorrhage along the vein, floaters, decreased vision, resolve spontaneously, superior temporal, A/V nicking Complications: macular edema, vitreous hem, neo, serous detachment; HTN cause
- Central Retinal Vein occlusion Mild-asymtomatic; Severe-reduced VA Associated with chronic glaucoma, vision improves over two to three months
- Branch Retinal Artery Occlusion Shething of the artery Sudden painless vision loss, transient vision obscuration
- Sickle Cell Retinopathy-Pre-proliferative Black Sunburst pigment in RPE Salmon patch is hem in periphery
- Sea fan Neovascularization Proliferative sickle cell
- Retinitis Pigmentosa Nyctalopia, tunnel vision, abnormal ERG, Rods and cones, bony spicules, attenuation of arterioles
- Cone-rod dystrophy salt n’ pepper retinopathy, bull’s eye maculopathy
- Lisch Nodules; Neurofibromatosis 1(more common) and 2-Von Recklinghausen Café au-lait spots Type 2-CN VIII bilateral masses-hearing loss, facial weakness, ringing in the ears
- Sturge-Weber Syndrome PWS, leptomeningeal angiomas, glaucoma with or without buphthalmos Not inherited
- Von Hippel Landau disease-AD tortuous arteries and veins, hemangioblastomas; Men in their thirties Hemes and exudates first sign
- Tuberous Sclerosis Seizures, mental retardation, skin and eye cyst-like lesions, multi-system disease
- Arteriole-Venous Shunt R/O Wyburn-Mason syndrome
- Stargardt’s Dz Scotoma limited to macula, periphery adequate, normal ERG/EOG, bilateral
- Best’s Dz Normal ERG, abnormal EOG Egg yolk-VA unaffected, scrambled-poor VA, bilateral
- X-Linked Retinoschisis Stable until 5 th or 6 th decade, “cart-wheel spoking pattern” Males, Negative-going ERG, vascular sheathing, tritan defect, dark adaptaion changes, metamorphopsia
- North Carolina Macular Dystrophy 1/3-scaterred drusen (20/20-25), 1/3 confluent drusen (20/20-20/40), 1/3 colobomatous or disciform lesion (20/40-20/800) AD
- AIDS retinopathy CWS, hemes, microaneurysms, Roth-spots- white area with red dot, perivascular sheathing Normal BVA
- Central Serous Chorioretinopathy Unilateral, sudden decreased VA, metamorphopsia, hyperopic shift, no inflammation/pain, CV problems, smoked-stack FA, spontaneous resolution
- Macular hole Elderly females, decreased central VA, absolute central scotoma & (+) Watzke if full thickness, macula redder than usual with lighter ring around it Vitreous is villian
- Vitreal Traction Syndrome Flashes
- Cellophane Maculopathy Asymptomatic Slight blurred Va & possible metamorphopsia if severe
- Familial drusen Autosomal dominant, temporal to macula, symmetrical, bilateral, normal VA, no systemic dz, normal ERG, abnormal EOG, no leakage with FA, no Neo
- ARMD Drusen => confluent drusen => serous detachment => geographic atrophy => disciform form scar & Neo Disciform scar, metamorphopisa-wavy dim line, signet-ring sign under macula
- Degenerative Myopia Post staphyloma, myopic crescent => peripapillary atrophy, decreased VA, lacquer cracks
- Posterior Staphyloma Congenital, bilatera, ring scotoma, dragged BV, thinning or RPE, bitemporal hemianopsia, high myopia w/ decreased VA, outpouching of eye
- Papilledema Enlarged BS, increased intracranial pressure, Paton’s folds, transient vision loss, hemes & exudates in papillary area
- Pseudotumor Cerebri Papilledema, enlarged BS, HA, increased ICP ON elevation, (-) CT, Nl VF & VA, Nl B-scan
- Glioblastoma Multiform HA, increased ICP, papilledema, enlarged BS, B-scan (+) mass, imaging
- Leber’s stellate maculopathy Decreased VA & VF, bilateral, macular star, unilateral swelling ON w/ inflammation, eye pain, RAPD, central scotoma, Cat scratch
- Optic Neuritis; Unilateral, pain upon eye movement, transient blurring, inflammation of ON, subacute loss of VA, APD, CV & VF defects Cat scratch; Young, white females Uhtoff’s & L’hermetes
- Optic neuritis in MS
- Alcohol Amblyopia Gradual painless bilateral loss of vision, central or centrocecal scotoma, temporal pallor of disc w/ occasional splinter heme, jaundice
- Juvenile Optic Atrophy (ADOA, Kjer-type) Bilateral slowly progessive loss of VA, inverted VF to color targets esp. blue-SWAP, temporal ON pallor
- AION Giant cell arteritis S-T ON pallor, I-N VF defect, HTN, DM, sudden monocular painless decreased vision
- Blonde Fundus
- Moderately pigmented fundus
- Darkly Pigmented Fundus…see NFL really well
- Medullated Fibers of ONH Possible reduced VA, relative scotoma limited to lesion, enlarged BD, white feathery area, benign, congenital
- CHRPE Jet black w/ sharp borders, relative scotoma in young pts, absolute scotoma in old pts
- Bear Tracks-CHRPE
- Amelanotic nevus B-scan to DDx osteoma => hyper-reflective
- Choroidal Malignant Melanoma Abrupt elevation, RPE disruption => VF loss, orange lipofuscin
- Choroidal Nevus Slate gray w/ feathery borders, drusen = old
- Sentinel Vessels
- Iris Melanoma
- Melanocytoma of ONH Unilateral, benign, normal VA or enlarged BS, no feeder vessels, tissue not disrupted
- Retinal Coloboma Inferior to ONH, no decreased VA, VF defect corresponds to area
- Coloboma of the iris
- Micro-ophthalmia & Optic disc coloboma Congenital autosomal dominant, permenant, non-progressive, bilateral, I-T disc
- Congential Optic Pit Unilateral, I-T optic cup, VA rarely affected, temporal pits => serous maculopathy, non-rhegmatogenous serous detachment, arcuate scotoma
- Morning Glory Disc anomaly Unilateral, 20/100 to hand motion, rare non-inheritied
- ON Hyporplasia Double ring sign, tortuous vessels, (+) APD, Strab esp. ET, VA & VF vary w/ severity
- ON Hypoplasia
- Tilted disc syndrome Major axis horizontal, VF defects, usually inferior staphyloma will cause a tilt in the disc
- Bergmeister Papillae
- Hyaloid artery remnant
- Persistent Hyperplastic vitreous Can cause retinal traction, congenital and stationary, unilateral, microphthalmia, CATS, GLC may be associated
- ROP stage 2 Temporally dragged disc, lower birth weight, younger gestational age, myopia, premes
- Ophthalmomyiasis Mobile larval parasite, enters the sclera, fly vivaparous, snail-like tracks at level of RPE
- Pigment Dispersion syndrome
- Early Arterial phase
- Late Arterial phase
- Early Venous phase
- Mid-venous phase
- Late venous phase
- Occult ARMD
- DR