Moorfields Half Day Teaching – August 2016

I hope those of you who attended the Half Day Teaching yesterday on Ophthalmic Pathology found it interesting and useful. Thanks to Didi for his talk on Ocular Oncology, and to Sam for giving her perspective on specimens from the laboratory viewpoint.

To refresh your memory, you can access a commented copy of my talk here.

Useful links I mentioned yesterday are:

https://eyepath.ucl.ac.uk/  – this is the Department of Eye Pathology web-based reports database where you can look up histopathology and cytology reports for your patients (if you are a legitimate person to have access, of course). You need to self register, and there is a link on the page for you to do that.

https://www.rcophth.ac.uk/wp-content/uploads/2016/07/Ocular-Pathology-July-2016.pdf – this is the recently updated RCOphth guidance on what kind of tissue removed at surgery should be sent (or need not be sent) for histological examination. I hope it’s a document of practical help, and if you’re coming up to exams I suggest you familiarise yourselves with it.

As a reminder, here are a few of the cases we looked at:


Temporal artery biopsy from an elderly patient with headaches and a raised ESR

Temporal artery biopsy x4, H&E
Temporal artery biopsy x4, H&E

Temporal artery biopsy. x20 H&E
Temporal artery biopsy. x20 H&E

The arterial lumen is obliterated, the wall thickened. There is a transmural infiltrate of lymphocytes and a very occasional multinucleate giant cell. This is temporal arteritis.


Orbital biopsy from a child. This appeared to be a cyst.

Orbital biopsy x10 H&E
Orbital biopsy x10 H&E

On the top right there is keratinising stratified squamous epithelium with a pilosebaceous unit, similar to skin. On the bottom left there is granulomatous inflammation with some cholesterol cleft and foreign body response. There are a couple of hair shafts. This is a dermoid cyst which has been disrupted with subsequent inflammation.


Corneal specimen from a patient with keratitisCornea. Gram stain x10

Cornea. Gram stain x10

Cornea. PAS x20
Cornea. PAS x20

There are clusters of Gram-positive bacteria within the stroma, with very little inflammation. On Descemet’s membrane there is a cluster of PAS-positive fungal hyphae. This patient has fungal keratitis with superimposed bacterial crystalline keratopathy.


Corneal specimen from a patient with poor vision

Anterior cornea. H&E x4
Anterior cornea. H&E x4
Anterior corneal lamella. Masson trichrome x10
Anterior corneal lamella. Masson trichrome x10

This anterior corneal specimen has “lumpy” bright pink (eosinophilic) deposits in the subepithelial and anterior stromal region. They stain bright red with Masson Trichrome. This is Reis-Bucklers dystrophy.

In a couple of weeks we’ll be circulating a sign-up email for my September live microscopy session. I hope to see some of you there! Also, if you’d be interested in visiting our department and seeing how we do things (or maybe having a go yourself like we did in April – please contact me and we can arrange something.

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