chapter  24
Diseases of the Eye and Ocular Adnexa
ByHarry H. Brown
Pages 58

The thought of pathological examination of ocular tissues to the general surgical pathologist may vary anywhere from apathy to annoyance to anathema, largely because the eye is a small and very complex organ. Its disease processes can be arcane, and accurate pathological diagnosis may require detailed clinical information, labor-intensive gross examination and histological techniques, and discriminating microscopic evaluation, all with a resultant low costbenefit ratio (literally and figuratively). Many ocular pathological processes are visible to the ophthalmologist clinically by biomicroscopy (slit lamp) or ophthalmoscopy, or by special instrumentation such as optical coherence tomography (OCT) or ultrasound biomicroscopy, and at higher magnification than usually available to the general surgical pathologist. Thus, clinically apparent findings may go undetected or unrecognized at the gross bench. Likewise, with such refined techniques, pathological processes are also often accurately diagnosed clinically and treated, so that a pathological diagnosis may not be necessary or critical to patient therapy and treatment. Perhaps the most dramatic example, melanoma of the uveal tract, is one of the few malignancies treated without a pathological tissue diagnosis.