A Histopathologist’s Guide to Ocular Pathology

  • M. Andrew Parsons


Ophthalmic pathology at autopsy can seem a daunting business to the uninitiated. However, it has much to offer scientifically and diagnostically once the initial fears are overcome. The procedures are no more difficult — once learned — than those in many other branches of pathology. As ever, the “secret” is in good preparation and thoughtful and careful execution of all of the technical procedures. Therefore I encourage you to consider working in this extremely interesting area of pathology.

The most important component of autopsy ophthalmic pathology practice remains that of ensuring that all appropriate permissions and informed consents have been obtained for taking and retaining tissues. It is vitally important that the family of the patient be fully consulted and informed about the procedures, that they can be reassured that the reasons for performing the procedures are valid, and that there is no possibility that their relative will be “mutilated” by the procedure. The pathologist’s role here is to ensure that family members can spend important time with their deceased relative after the procedures have taken place, should they wish.

Specialist ophthalmic pathologists are available for consultation in individual cases. Most of us are very happy to receive case material from other pathologists should they wish to refer it and obviously to provide feedback of the results to both pathologists and clinicians.


Optic Nerve Blunt Trauma Physical Child Abuse Abusive Head Trauma Ocular Pathology 
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  1. 1.
    Parsons MA, Start RD. Necropsy techniques in ophthalmic pathology. ACP Best Practice No. 164. J Clin Pathol 2001;54:417–425.CrossRefPubMedGoogle Scholar
  2. 2.
    Underwood JCE. Autopsies and clinical audit. In: Cotton DWK, Cross SS, editors. The hospital autopsy. Oxford: Butterworth-Heinemann, 1993:163–172.Google Scholar
  3. 3.
    The autopsy and audit. Report of the Joint Working Party of The Royal College of Pathologists, The Royal College of Physicians of London and The Royal College of Surgeons of England. London: The Royal College of Pathologists, 1991.Google Scholar
  4. 4.
    Spencer RC. The microbiology of the autopsy. In: Cotton DWK, Cross SS, editors. The hospital autopsy. Oxford: Butterworth-Heinemann, 1993:144–157.Google Scholar
  5. 5.
    Blotnick CA, Powers TP, Newland T, McMillan T, Bluestein EL, Apple DJ. Pathology of silicone intraocular lenses in human eyes obtained postmortem. J Cataract Refract Surg 1995;21:447–452.PubMedGoogle Scholar
  6. 6.
    Hansen SO, Tetz MR, Solomon KD, et al. Decentration of flexible loop posterior chamber intraocular lenses in a series of 222 postmortem eyes. Ophthalmology 1988;95:344–349.PubMedGoogle Scholar
  7. 7.
    Apple DJ, Park SB, Merkley KH, et al. Posterior chamber intraocular lenses in a series of 75 autopsy eyes. Part 1: Loop location. J Cataract Refract Surg 1986;12:358–362.PubMedGoogle Scholar
  8. 8.
    Sisley K, Rennie IG, Parsons MA, et al. Abnormalities of chromosomes 3 and 8 in posterior uveal melanoma correlate with prognosis. Genes Chromosomes Cancer 1997;19:22–28.CrossRefPubMedGoogle Scholar
  9. 9.
    Pavlin CJ, Machen P, Trope GE, Heathcote G, et al. Ultrasound biomicroscopic imaging of the effects of YAG laser cycloablation in postmortem eyes and living patients. Ophthalmology 1995;102: 334–341.PubMedGoogle Scholar
  10. 10.
    Green MA, Lieberman G, Milroy CM, Parsons MA. Ocular and cerebral trauma in non-accidental injury in infancy: underlying mechanisms and implications for paediatric practice. Br J Ophthalmol 1996;80:282–287.PubMedGoogle Scholar
  11. 11.
    Forrest ARW. Toxicological and biochemical analysis. In: Burton J, Rutty GN, editors The hospital autopsy. 2nd ed. London: Arnold, 2001:126–133.Google Scholar
  12. 12.
    Forrest ARW. Obtaining samples at post mortem examination for toxicological and biochemical analyses. J Clin Pathol 1993;46:292–296.PubMedGoogle Scholar
  13. 13.
    Mittleman RE, Steele B, Moskowitz L. Postmortem vitreous humor in fatal acute iron poisoning. J Forensic Sci 1982;27:955–957.PubMedGoogle Scholar
  14. 14.
    McKinney PE, Phillips S, Gomez HF, Brent J, MacIntyre M, Watson WA. Vitreous humor cocaine and metabolite concentrations: do postmortem specimens reflect blood levels at the time of death? J Forensic Sci 1995;40:102–107.PubMedGoogle Scholar
  15. 15.
    Knight B. The coroner’s autopsy. A guide to non-criminal autopsies for the general pathologist. Edinburgh: Churchill Livingstone, 1983:16.Google Scholar
  16. 16.
    Parsons MA, Start RD, Forrest ARW. Concurrent vitreous disease may produce abnormal vitreous humour biochemistry and toxicology. J Clin Pathol 2003;56:720.CrossRefPubMedGoogle Scholar
  17. 17.
    Jones AW, Holmgren P. Uncertainty in estimating blood ethanol concentrations by analysis of vitreous humour. J Clin Pathol 2001;54:699–702.PubMedGoogle Scholar
  18. 18.
    Sousa AP, Viera DN, Oliveira MMF, Marques EP, Monanto PV. Comparison between ethanol levels of vitreous humour on both eyes in the same individual. Proceedings of the XXXV Annual Meeting, The International Association of Forensic Toxicologists, Padova: Centre of Behavioural and Forensic Toxicology, University of Padova, 1997:574–578.Google Scholar
  19. 19.
    Adams JH, Murray MF. Atlas of post-mortem techniques in neuropathology. Cambridge: Cambridge University Press 1982.Google Scholar
  20. 20.
    Brown P, Wolff A, Gajdusek DC. A simple and effective method for inactivating virus infectivity in formalin-fixed tissue samples from patients with Creutzfeldt-Jakob disease. Neurology 1990; 40:887–890.PubMedGoogle Scholar
  21. 21.
    Van der Valk P. Prion diseases: what will be next? J Clin Pathol 1998;51:265–269.PubMedGoogle Scholar
  22. 22.
    Lee WR. Examination of the globe: technical aspects. In: Lee WR, editor. Ophthalmic histopathology. 2nd ed. London: Springer-Verlag, 2002:1–33.Google Scholar
  23. 23.
    Lowe DG, Jeffrey IJM. Central nervous system and eye. In: Lowe DG, Jeffrey IJM, editors. Macro techniques in diagnostic histopathology. Ipswich, UK: Wolfe Medical Publications, 1990:136–140.Google Scholar
  24. 24.
    Lee WR. Ophthalmic histopathology. 2nd ed. London: Springer-Verlag, 2002.Google Scholar
  25. 25.
    Gilliland MGF, Folberg R. Retinal hemorrhages: replicating the clinician’s view of the eye. Forensic Sci Int 1992;56:77–80.CrossRefPubMedGoogle Scholar
  26. 26.
    Eagle RC, Jr. Pathology. Photographic tips for the Opthalmic Pathology Laboratory. In: Wilson RP (ed). Yearbook of opthalmology 1997. Mosby Year Book Inc: St. Louis, 1997:341–354.Google Scholar
  27. 27.
    David TJ. Avoidable pitfalls when writing medical reports for court proceedings in cases of suspected chills abuse. Arch Dis Child 2004;89:799–804.CrossRefPubMedGoogle Scholar
  28. 28.
    Gilliland MGF, Luthert P. Why do histology on retinal haemorrhages in suspected non-accidental injury? Histopathology 2003;43:592–602.CrossRefPubMedGoogle Scholar
  29. 29.
    Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain 2001;124 (pt 7):1290–1298.PubMedGoogle Scholar
  30. 30.
    Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain 2001;124 (pt 7): 1299–1306.PubMedGoogle Scholar
  31. 31.
    Punt J, Bonshek RE, Jaspan T, McConachie NS, Punt N, Ratcliffe JM. The “unified hypothesis” of Geddes et al. is not supported by the data. Pediatr Rehabil 2004;7:173–184.PubMedGoogle Scholar
  32. 32.
    Levin A. Retinal haemorrhages and child abuse. In: David TJ, editor. Recent advances in paediatrics. Edinburgh: Churchill Livingstone, 2000:151–219.Google Scholar
  33. 33.
    Taylor D, Bonshek R, Carter N, et al. Child abuse and the eye. The Ophthalmology Child Abuse Working Party. Eye 1999;13 (pt 1): 3–10.Google Scholar
  34. 34.
    Adams G, Ainsworth J, Butler L, et al., Child Abuse Working Party. Update from the Ophthalmology Child Abuse Working Party: Royal College Ophthalmologists. Eye 2004;18:795–798.PubMedGoogle Scholar
  35. 35.
    Taylor D. Unnatural injuries. Eye 2000;14:123–150.PubMedGoogle Scholar
  36. 36.
    Starling SP, Holden JR, Jenny C. Abusive head trauma: the relationship of perpetrators to their victims. Pediatrics 1995;95:259–262.PubMedGoogle Scholar
  37. 37.
    Mian SI, Azar DT, Colby K. Management of traumatic cataracts. In: Ray SK, Jakobiec FA, editors. Ocular Trauma Int Ophthalmol Clin 2002;42:23–31.Google Scholar
  38. 38.
    Duke-Elder S, Macfaul PA. Concussion effects on the lens and zonule. In: Duke-Elder S (ed). System of ophthalmology, vol. XIV, part 1, mechanical injuries. London: Henry Kimpton, 1972:121–142.Google Scholar
  39. 39.
    Yanoff M, Fine BS, Schaffer DB. Histopathology of transient neonatal lens vacuoles. Am J Ophthalmol 1973:76:363–370.PubMedGoogle Scholar
  40. 40.
    Hamill MB. Clinical evaluation. In: Shingleton BJ, Hersh PS, Kenyon KR, editors. Eye trauma. St. Louis: Mosby, 1991:3–40.Google Scholar
  41. 41.
    Duke-Elder S, Macfaul PA. Concussion changes in the vitreous. In: Duke-Elder S (ed). System of ophthalmology, vol XIV, part 1, mechanical injuries. London: Henry Kimpton, 1972:194–198.Google Scholar
  42. 42.
    Blight R, Dean Hart JC. Structural changes in the outer retinal layers following blunt mechanical non-perforating trauma to the globe: an experimental study. Br J Ophthalmol 1977;61:573–587.PubMedGoogle Scholar
  43. 43.
    Sipperley JO, Quigley HA, Gass DM. Traumatic retinopathy in primates. The explanation of commotion retinae. Arch Ophthalmol 1978;96:2267–2273.PubMedGoogle Scholar
  44. 44.
    Mansour AM, Green WR, Hogge C. Histopathology of commotio retinae. Retina 1992;12:24–28.PubMedGoogle Scholar
  45. 45.
    Friberg TR. Traumatic retinal pigment epithelial edema. Am J Ophthalmol 1979;88:18–21.PubMedGoogle Scholar
  46. 46.
    Cross SS. Autopsies, the deceased’s relatives and the law. In: Cotton DWK, Cross SS, editors. The hospital autopsy. Oxford: Butterworth-Heinemann, 1993:8–14.Google Scholar
  47. 47.
    Human Tissue Act, 1961 s.1.Google Scholar
  48. 48.
    Guidelines for the retention of tissues and organs at post-mortem examination. London: The Royal College of Pathologists, 2000.Google Scholar
  49. 49.
    Corneal Tissue Act, 1986 s.1.Google Scholar
  50. 50.
    National Health Service and Community Care Act 1990, Sched.9.Google Scholar
  51. 51.
    Consensus statement of recommended policies for uses of human tissue in research education and quality control. London: Royal College of Pathologists, 1999.Google Scholar
  52. 52.
    Harris DM. Biological safety. In: Cotton DWK, Cross SS, editors. The hospital autopsy. Oxford: Butterworth-Heinemann, 1993:15–31.Google Scholar
  53. 53.
    Mietz H, Heimann K, Kuhn J, Wieland U, Eggers HJ. Detection of HIV in human vitreous. Int Ophthalmol 1993;17:101–104.CrossRefPubMedGoogle Scholar
  54. 54.
    Advisory Committee on Dangerous Pathogens. Precautions for work with human and animal transmissible spongiform encephalopathies. Second impression. London: HMSO, 1994.Google Scholar
  55. 55.
    Advisory Committee on Dangerous Pathogens. Anatomy procedures on donor bodies suspected to have had, or to have been at risk of developing, Creutzfeldt-Jakob disease (CJD) or Gerstmann-Straussler-Scheinker Syndrome (GSS). Department of Health Circular PL(92)CO/4. London: Department of Health, 1994.Google Scholar
  56. 56.
    Bell JE, Ironside JW. How to tackle a possible Creutzfeldt-Jakob disease autopsy. J Clin Pathol 1993; 46:193–197.PubMedGoogle Scholar


  1. 1.
    Farr R, Wheeler P, Parsons MA. The Sheffield Head Photographic Protocol [2005]. Available from: Scholar

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© Springer-Verlag London Limited 2006

Authors and Affiliations

  • M. Andrew Parsons
    • 1
  1. 1.Royal Hallamshire HospitalUniversity of SheffieldSheffieldUK

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