on b
Cytology of Other Body Sites
chapter
1 7
Eye
Kiran F Narsinh, Diane B Mandell, and Ben J Glasgow
Contents
In tro d u c tio n
A n a to m y a n d H is to lo g y
S a m p lin g a n d C y to p re p a ra to ry T e c h n iq u e s
E y e lid s
S c ra p in g
C o n ju n c t iv a a n d C o rn e a
F in e - N e e d le A s p ir a t io n
In t r a o c u la r ( V it r e c t o m y ) W a s h in g
E ye
S p e c ia l T e c h n iq u e s
D ia g n o s tic A c c u ra c y
T o D e t e c t
C h la m y d ia
O r g a n is m s
C o n c lu d in g R e m a rk s
T o D e t e c t V ira l C y t o p a th ic E ffe c t (C p E)
Introduction
The study of ocular specimens presents a number of challenges
for cytopathologists. The specimens are usually scant as the
lesions in the eye are usually very small compared to other sites
in the body. Furthermore, the diseases in the eye are unique
and require specialized expertise and experience to interpret.
Knowledge of the clinical aspects of the disease is often critical
to the overall interpretation of the sample. There are many arti-
cles in the ocular cytopathology literature that deal with infec-
tious conjunctivitis, melanoma, and retinoblastoma.1-10 Adding
to the complexity of interpretation, the imaging techniques
and methodologies to obtain samples by needle aspiration and
vitreous washing have improved.9
The major experience presented in this chapter is gathered
from the archives of the University of California, Los Angeles
(UCLA) Cytology Service and the Jules Stein Eye Institute
(JSEI).11-13 This is a referral practice, with lesions and disease
situations that general ophthalmic practices rarely encounter or
treat.
Because many lesions found in this area are common to
other parts of the body, they are mentioned briefly in this chap-
ter, with reference to the appropriate chapter where the lesion
is more fully described. Only those lesions that have unique
features referable to the eye and its adnexa are explored here in
depth.
Sampling and Cytopreparatory Techniques
Most lesions of the eyelid, eye, and orbit are approached by
fine-needle aspiration (FNA). Cytology samples from the con-
junctiva and cornea are usually smears or scrapings. If the proc-
ess involves the vitreous, a vitreous aspiration or vitrectomy is
generally performed and the material is drained into a sterile
cassette during surgery. Abbreviations (S, FNA, and IOW) are
used to indicate the most common method of sampling as each
lesion or disease process is described.
Scraping
Lesions appropriate for scraping require local anesthesia, fol-
lowed by a swabbing, brushing, or scraping. A variety of imple-
ments including a small sterile platinum spatula or brush may
be used. The cellular yield is then smeared onto one or more
slides, depending on the amount of material. To avoid air-drying,
the slide can be positioned horizontally and flooded with 95%
alcohol after smearing.14
Fine-Needle Aspiration
FNA of the eye must be undertaken by a skilled and trained oph-
thalmologic surgeon. Depending on the location of the target
lesion, localization by imaging techniques may be required.
intraocular (Vitrectomy) Washing
The pars plana (closed) vitrectomy was initially described in the
early 1970s.15-19 The original vitrectomy instrument had cutting,
suction, and infusion capabilities. It was able to remove intra-
ocular tissues such as vitreous, blood, fibrovascular membranes,
lens material, and inflammatory debris. Continual refinements
have led to the development of new instruments with scissors
capability, a self-contained fiberoptic light source, and intraocu-
lar photocoagulation with diathermy capabilities (Fig. 17.1).
The underlying surgical goal of vitrectomy is removal of either
vitreal opacities, such as hemorrhage, or intravitreal fibrous
strands. If not removed, fibrous strands may contract, causing
tractional retinal detachments,20 with resultant decreased vision
or blindness. Vitrectomy is most often performed on patients
with proliferative diabetic retinopathy.16,21,22 The vitrectomy
instrument is able to remove nonresorbed vitreous hemorrhage,
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