BAGIAN PATOLOGI ANATOMI

FAKULTAS KEDOKTERAN USU MEDAN 2007

NORMAL ANATOMY
Palpebrae Conjunctiva Cornea Lens Uvea tract Retina Vitreous humor Nerve Gland Muscle Blood vessels

NORMAL ANATOMY
A - Vitreous humor B - Lens C - Cornea D - Pupil E - Iris F - Sclera G - Optic Nerve H - Retina

CHOROID
CHOROID = MIDDLE LAYER EYE CONTAINS :
BLOOD VESSELS & CONNECTIVE TISSUE

SUPPLIES NUTRIENTS TO INNER PORTION OF EYE

CILIARY BODY
CILIARY BODY = ring of tissue encircles the lens. Contains :
smooth muscle fibers (ciliary muscles) control the shape of the lens.

Posterior surface lens (CILIARY PROCESSES) Contain : capillaries

Secrete fluid (vitreous humor) into the anterior segment of the eyeball.

LACRIMAL SYSTEM
LARGELY : SEROUS TYPE

MINOR MUCINOUS

DISORDER OF EYE
MICRO ORGANISMS * ANTIGEN * TOXIC CHEMICAL * SOLAR RADIATION * SYSTEMIC DISEASE * * BLINDNESS

CONGENITAL ANOMALI
RARELY : - ANOPTHTHALMOS - EYES (-) (- MICROPHTHALMOS - MEDIAN EYE - HYPOPLASIA EYES - COLOBOMA - CONGENITAL CATARACTS - COLOR BLIND

COLOBOMA
(Defect in iris)

Appear : black notch pupil : irregular (shape) May be associated with :

Hereditary conditions Trauma to the eye, or Eye surgery

CONGENITAL CATARACTS
The number of people born with cataracts is low. Possible causes :
Galactosemia Chondrodysplasia syndrome Congenital rubella syndrome Down syndrome (trisomy 21) Pierre-Robin syndrome PierreFamilial congenital cataracts Hallerman-Streiff syndrome HallermanLowe syndrome Trisomy 13 Conradi syndrome Ectodermal dysplasia syndrome Marinesco-Sjogren syndrome Marinesco-

CONGENITAL CATARACTS

PIGMENTATION
EXOGEN
ENDOGEN

IRON COPPER SILVER

MELANIN
ALBUMIN MELANOSIS

HEMOSIDERINE
I.O.H

PIGMENTATION
KAYSER - FLEISCHER RING WILSONS DISEASE (HEPATOLENTI CULAR DEGENERATION)

DEPIGMENTATION
VITILIGO

PHYSICAL & CHEMICAL INJURIES

TRAUMA : ECCHYMOSIS SUP.FICIAL : CONTACT LENS FOREIGN BODIES ULTRA VIOLET CAUSTIC CHEMICAL BLUNT TRAUMA FRACTURE OF BONE

SKIN APPENDAGES OF EYELIDS

1.

SEBACEOUS GLANDS (ZEIS & MEIBOMIAN) APOCRINE GLANDS (MOLL) ECCRINE SWEAT GLANDS

2.

3.

MOLUSCUM CONTANGIOSUM
VIRAL INFECT WART LIKE CENTRAL UMBILICAL KERATIN

CYSTIC LESSION
SUDORIFERA SEBACEA MEIBOMIAN DERMOID

HORDEOLUM ( = STYE )
ZEIS GLAND (SEBACEOUS GLANDS) EXTERNAL HORDEOLUM MEIBOMIAN GLANDS HORDEOLUM INTERNAL

FOLICLE INFECTION STAPHYLLOCOCUS CELLULITIS

HORDEOLUM

EXTERNAL

INTERNAL

CHALAZION
(MEIBOMIAN GLAND LIPOGRANULOMA)
A PAINLESS GRANULOMA OF THE MEIBOMIAN GLANDS MEIBOMIAN GLAND OCCLUTION CHRONIC GRANULATION

MICROSCOPIC
MULTIPLE FOCI OF GRANULOMATOUS INFLAMMATION

XANTHELASMA
SHARPLY DEMARCATED YELLOWISH (COLLECTION CHOLESTEROL) UNDERNEATH SKIN USUALLY : ON / AROUND EYELIDS ASSOCIATIONS :
CHOLESTEROL (FAMILIAL HYPERCHOL) PRIMARY BILIARY CIRRHOSIS MENOPAUSE DIABETES

EXOPTHALMUS ( = PROPTOSIS )
PROTUSION (EYEBALL) BILATERAL THYROID DISEASE EARLY ADULT LIFE (WOMEN), 4/1 + EDEMA (EYELID, CHEMOSIS)

EXOPTHALMUS ( = PROPTOSIS )
PATHOLOGY: ORBITAL WATER >> EXT.OCULAR MUSCLE >> ( + LYMPHOCYTES & MN ) CLINIC : EXPOSURE CONJTIVA BLIDING, ULCERATION, OPTIC NERVE COMPRESSION

CONJUNCTIVA DISORDER
HYPEREMIA HEMORRHAGE INFLAMATION THRACHOMA CHLAMYDIAL INFECTION OPHTHALMIA NEONATORUM DRYDRY-EYE SYNDROME PINGUECULA & PTERYGIUM

HYPEREMIA - CONJUCTIVA
DILATASI BLOOD VESEL CONJUNCTIVITIS CORNEA DISEASE IRIDOCYCLITIS CORNEA DEFECT GLAUCOMA IRITIS

HEMORRHAGE CONJUNCTIVA
TRAUMA ANOXIA SEVERE COUCHING

SPONTANEUS

SUBCONJUNCTIVAL HEMORRHAGE
Causes :
Minor eye trauma Spontaneously (venous press ) Streneuous Exercising Coughing Touching/widening eyes Sneezing Vomiting (bulimia nervosa) Severe alcohol intoxication, blood press Severe hypertension

CONJUNCTIVITIS
MICROMICRO-ORG CONJUNCTIVITIS KERATITIS CORNEAL ULCER

HEMATOGEN IATROGENIC INFECTION SURGICAL : CATARACT CORNEAL GRAFT PROSTHETIC LENS

CONJUNCTIVITIS
EXUDATE/DISCHARGE : - PURULENT CLOSE - FIBRINOUS - SEROUS - HEMORRHAGIC

CONJUNCTIVITIS

TRACHOMA
INF.CHRONIC (CLAMYDIA TRACHOMATIS) = SWIMMING POOL CONJUNCTIVITIS OCULAR, GENITAL, SYSTMIC BLIND CHILD ADULT REMISION (SP) PROGRESSIVE

BILATERAL, SUP > INF

NEW BORN : PURULENT CONJUNC. (BLENORRHOE) ADULT :

CHRONIC FOLLICLE CONJ. LYMPHOCYTE (+) HYPERPLASIA GERM. CENTRE NECROTIC TRACHOMATOUS PANNUS

(EPIT BOWMANN ZONE)

FIBROSIS (CONJ. & EYELIDS)
DISTORS EYELIDS PATHOLOGY : LOWER TARSAL CONJUNTIVA SCAR & NECROTIC (-) ( KERATITIS (-) (-

TRACHOMA
(CHLAMYDIAL CONJUNCTIVITIS)

OPHTHALMIA NEONATORUM
ACUTE SEVERE CONJUNCTIVITIS COPIUS PURULENT DISCHARGE GO GO-NEONATORUM GOULC.CORNEA, PERFORATION SCAR & PANOPHITIS BLIND PREVENT SILVER NITRAT (PNC)

OPTHALMIA NEONATORIUM

Microbial Agent : Neisseria gonorrhoeae Mode of Transmission: From mother to newborn Classic Feature: purulent destructive eye disease

DRY EYE SYNDROME

Common condition Tear production << (ocular & systemic disease) Older , menopause Assc.: SJOGREN DISEASE (keratoconjunctivitis sicca) middle aged (atrophy of lacrimal glands)

Common causes :
Aging Dry environment or workplace (wind, air conditioning) Sun exposure Smoking / smoke exposure Cold / allergy medicines Sjogren's syndrome includes dry eyes, mouth & mucus membranes often RA / other joint disorder

The result of :
Sensitivity of the cornea Evaporation of tears Disorder in the glands

PINGUECULA
LUMP YELLOWISH NASAL TO THE CORNEOSCLERAL SUN DAMAGED INJURY DOES NOT GROW ONTO CORNEA DEPOSIT OF PROTEIN & FAT PARTICULARLY OLDER PEOPLE

PINGUECULA

PTERYGIUM
FOLD OF VASCULARIZED RECURS AFTER EXISION (PINGUECULA) GROWS : TRIANGULAR SHAPE OVER THE CORNEA (THE TRANSPARENT PART OR FRONT WINDOW OF THE EYEBALL).

MAY GROW LARGE ENOUGH TO INTERFERE WITH VISION COMMONLY : INNER CORNER OF THE EYE (APEX PUPIL)

PTERYGIUM

CLOUDY CORNEA
CORNEA : TRANSPARENT STRUCTURE LESS TRANSPARENT & CLOUDY : METABOLIC DISEASES TRAUMA INFECTIOUS DISEASES NUTRITIONAL DEFICIENCIES & ENVIRONMENTAL IT CAN LEAD TO VARIOUS DEGREES OF VISION LOSS.

CORNEA
HERPES SIMPLEX ONCHOCERCIASIS ARCUS SENILIS BAND KERATOPATHY CORNEAL DYSTROPHIES

HERPES KERATITIS

HYPEREMIA (TRAUMA)

EYE LENS ANATOMY

THE LENS OF THE EYE IS NORMALLY CLEAR.

LENS
CATARACT PRESBYOPIA PHACO ANAPHYLACTIC ENDOPHTHALMITIS

CATARACT

THE LENS OF THE EYE IS NORMALLY CLEAR. IF THE LENS BECOMES CLOUDY OR IS OPACIFIED IT IS CALLED A CATARACT

NORMAL, NEAR & FARSIGHTEDNESS

UVEA
SYMPATHETIC OPHTHALMITIS SARCOIDOSIS

RETINA
HEMORRHAGE OCCLUSIVE VASC.DISEASE - CENTRAL R. ART.OCCLUSION - CENTRAL R. VEIN OCCLUSION HYPERTENSIVE RETINOPATHY DIABETIC RETINOPATHY RETINAL DETACHMENT

RETINA
RETINITIS PIGMENTOSA MACULAR DEGENERATION CHERRYCHERRY-RED SPOT AT THE MACULA ANGIOID STREAKS RETINOPATHY OF PREMATURITY

OPTIC NERVE
OPTIC NERVE HEAD EDEMA OPTIC ATROPHY

EFFECTS OF INCREASE INTRAOCULAR PRESSURE

GLAUCOMA CORNEA/SCLERA BULGES OPTIC ATROPHY

GLAUCOMA
GLAUCOMA IS A CONDITION OF INCREASED FLUID PRESSURE INSIDE THE EYE. Increased pressure causes compression of : Retina and Optic nerve Nerve damage. Glaucoma can cause :
Partial vision loss, Blindness as a possible eventual outcome.

GLAUCOMA
CONGENITAL GLAUCOMA INFANTILE GLAUCOMA, BUPHTHALMOS PRIMARY OPEN-ANGLE GLAUCOMA OPENPRIMARY CLOSED-ANGLE GLAUCOMA CLOSEDSECONDARY GLAUCOMA LOWLOW-TENSION GLAUCOMA

GLAUCOMA

NEOPLASMA
BENIGN
XANTHELASMA NEUROFIBROMA PAPILLOMA LIPOMA HEMANGIOMA LIMPHANGIOMA NEVUS

MALIGNANT
BOWEN DISEASE SQ.CELL.CA BASAL CELL CA MALIG. MELANOMA AD. CARCINOMA SARCOMA LYMPHOMA

XANTHELASMA
HYPERCHOLESTEROLEMIA DM REPRODUCTION WOMAN LOC : CANTUS INTERNAL PAL PEBRAE XANTHELASMA FOAMY CELLS MICRO INTRA CYTO PLASMA VACUOLE.

NEUROFIBROMA
SINGLE OR MULTIPLE NEUROFIBRO MATOSIS (VON RECKING HAUSEN.D) LOC. PALPEBRAE OTHER SITE (+)

PAPILLOMA
STOLK (+) SQ.EPITH.CELL PROLIFERATION

LYMPHANGIOMA
LESS COMMON LYMPH VESSEL PROLIFERATION LUMP

NEVUS
EPITHELIAL CELLS NEVI CELLS TYPE : - INTRA DERMAL - JUNCTIONAL - COMPOUND

BOWEN DIASEASE
INTRA EPITHELIAL NEOPLASM CA INSITU ATIPICAL CELLS PLEOMORFISM UNCOMMON

SQUAMOUS CELL CA
EPITHELIAL CELLS FORM : - NON KERATINIZING - KERATINIZING PLEOMORFISM CELLS HYPERCHROMATIC NUCLEUS KERATIN (+/-) (+/-

BASAL CELL CA
BASAL CELLS MONOTON NUCLEUS BASOPHYLIC STRAND PALISADE (+)

MALIGNANT MELANOMA
UVEAL MELANOMA MELANOCYTE OR NEVI CELLS CHOROID (COMMON SITE) TYPE : MELANOCYTE/AMELANOCYTE MACR : - CIRCUMSCRIBED - INV.BRUCHS MEMBRANE MICR : - SPINDLE CELLS - POLYGONAL CELLS - EPITHELOID CELLS

ADENO CARCINOMA
GLAND PATERN UNCOMMON DIFFERENTIATED : - WELL - MODERATE - POORLY

SARCOMA
CONNECTIVE TISSUE RHABDO/LEIOMYO SA FIBRO SA LIPO SA

LYMPHOMA
LYMPHOID TISSUE ROUND CELLS MONOTONE TYPE : - IMMATURE CELLS - MATURE CELLS

RETINOBLASTOMA
IMMATURE CELLS CHILD ( >> ) FIRST 2 YRS OF LIFE BIRTH ( +/- ) +/-

RETINOBLASTOMA
PATH : - INTERNAL VITR.BODY - EXTERNAL CREAM COLORED CALCIFIED YELLOW MICR : - SMALL CELLS - ROUND CELLS - ROSET (+) - NECROSIS - HEMORRHAGIC

RETINOBLASTOMA
EARLY DIAG OPERATIVE SURVIVAL ( 90 % ) UNTREATED FATAL INCIDENT 1/20000 (BIRTH) FAMILIAL ( 5 10 % ) CHROMOSOME 13 (-) (Q 14 BAND

RETINOBLASTOMA
CLINIC : WHITE PUPILS ( LEUCORIA) POOR VISION HYPEMIA STARBISMUS RED PAINFUL EYE

INTRAOCULAR PHOTOGRAPH OF AN ISOLATED "ENDOPHYTIC" RETINOBLASTOMA

GLIOMA NERVE OPTICUS

UNCOMMON CHILD AND ADULT NEUROFIBROMATOSIS GLIOMA VISION << (PROGRESIVA) PROPTOSIS PAPIL EDEMA MICR : - ASTROSITOMA LIKE CELLS - WELL DIFFERENTIATED SURGICAL AND RADIOTH/ OK 5 YSR 90 %

METASTATIC NEOPLASM
MORE COMMON X PRIMER PRIMER LESSION : - LEUKEMIA - BREAST CA - LUNG CA DIAG : AFTER DEATH