17
Eye
Fig. 17.4 Herpetic conjunctivitis. Conjunctival scrape shows enlarged cells
with intranuclear clear inclusions (Papanicolaou x OI).
Key features of chalazion
• Granulomatous inflammatory reaction with foamy
histiocytes;
• Numerous polymorphonuclear leukocytes, plasma
cells, and lymphocytes; and
• Multinucleated giant cells may be present.
Sebaceous carcinoma
Sebaceous carcinoma arises from sebaceous (Meibomian and
Zeis) glands in the eyelid. Fine-needle aspiration reveals numer-
ous single cells and clusters of cells with foamy cytoplasm,
enlarged nuclei, and prominent nucleoli.12
Key features of sebaceous carcinoma
• Large cells with foamy cytoplasm;
• Enlarged nuclei;
• Prominent nucleoli; and
• Abundance of mitotic figures.
Juvenile xanthogranulom a (FNA OW)
Juvenile xanthogranuloma usually presents to the ophthalmol-
ogist with iris lesions in combination with skin lesions in chil-
dren. The iris lesions may produce hemorrhage in the anterior
chamber. Samples may be obtained by FNA of the skin although
specimens are usually obtained from anterior chamber paracen-
tesis in the course of treatment of the hyphema. Cytology prepa-
rations show histiocytes with foamy cytoplasm and rare Touton
giant cells.42
Key features of juvenile xanthogranuloma
• Granulomatous inflammatory reaction with many
histiocytes; and
• Touton giant cells may be present.
Conjunctiva and Cornea
Smears of normal conjunctiva and cornea show clusters and sin-
gle epithelial cells that have a squamous to cuboidal appearance
depending on the anatomic site. Interspersed between the con-
junctival epithelial cells are mucus-containing goblet cells. Both
cell types contain single round or oval nuclei with finely granular
Fig. 17.5 Vernal conjunctivitis. Conjunctival epithelial cells are
intermingled among lymphocytes and bilobed eosinophils.
(May-Grünwald-Giemsa x HP).
chromatin and small inconspicuous nucleoli. The cytoplasmic
vacuole in the goblet cell displaces the nucleus toward the base-
ment membrane. When these cells are scraped, the nonsecretory
columnar cells appear as a honeycomb with centrally placed
nuclei or as palisading clusters. Goblet cells are intermixed, the
nuclei eccentrically placed by the adjacent vacuole. No cilia or
terminal bars are present on either cell type.
Bacterial and Viral Conjunctivitis
These are best diagnosed by culture, but the exudate can contain
cells in distinctive patterns to provide a screening procedure.
When classic viral inclusions are identified in conjunctival cells
(Fig. 17.4), a presumptive diagnosis can be provided.43
Key features of bacterial and viral conjunctivitis
• Identification of the offending organism by appropri-
ate stain.
Vernal Conjunctivitis
Evidence suggests that vernal conjunctivitis is a recurrent hyper-
sensitivity reaction of the conjunctiva, occurring in atopic-
allergic patients. It is produced by mucosal presentation of an
antigen, such as common ragweed. Increased levels of IgE have
been found in the serum and tears of such patients.44
Smears from allergic conjunctivitis contain inflammatory
cells, including eosinophils, mast cells, or basophils and lym-
phocytes (Fig. 17.5).45 Goblet cells may be abundant if there
is a reactive hyperplasia (Fig. 17.5). Recent cytological studies
indicate that the expression of a wide spectrum of epithelial cell
adhesion proteins and cytoskeletal elements is downregulated
in the conjunctiva of seasonal allergic conjunctivitis patients,
perhaps impacting the ability of the epithelium to protect itself
against allergen penetration.46
Key features of vernal conjunctivitis
• Inflammatory infiltrate with eosinophilic predomi-
nance.
Chlam ydial Conjunctivitis (Trachoma and Trachom a
Inclusion Conjunctivitis) (S)
Unfortunately, the characteristic inclusions of
Chlamydia
are
not frequently found in conjunctival smears.47 According to
one report in the literature, only 8% of culture-positive cases
of chlamydial conjunctivitis had detectable inclusions, with an
459
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