EYE DISEASE
Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

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Freely have you received, give freely With one of four large boxes of "Pathguy" replies.

I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

I am presently adding clickable links to images in these notes. Let me know about good online sources in addition to these:

Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the eighteen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!

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More of Ed's Notes: Ed's Medical Terminology Page

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Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

If nature had wanted you to be a specialist, she'd have had you born with one eye with a microscope fastened to it.

{21860} normal fundus
{21863} normal fundus

KCUMB Students
"Big Robbins" -- Eye
Lectures follow Textbook

QUIZBANK

Skin / Eye (?!)
Taiwanese pathology site
Good place to go to practice

Eye and Ear
Photo Library of Pathology
U. of Tokushima

Eye pathology site

Eye
Iowa Virtual Microscopy
Have fun

Eye Pathology
For allied health professionals
Many clinical photos on this site

LEARNING OBJECTIVES for this unit...

INTRODUCING THE EYE


When I was a kid, there
was no routine screening

SELECTED EYE WORDS

{22238} coloboma

{13179} dacryocystitis

{22830} drusen
{22832} drusen

{22180} keratoconus

{22092} papilledema

BIRTH DEFECTS: A selection

{15608} Brushfield's spots

{20115} cherry red spot

LID PROBLEMS

{13143} chalazion

VITAMIN A DEFICIENCY (Br. Med. J. 310: 1051, 1995; Am. J. Clin. Nutr. 73: 1045, 2001)

TRACHOMA (Br. Med. J. 362: 223, 2001; Lancet 362: 223, 2003; NEJM 358: 1777, 2008; Lancet 371: 1945, 2008; Lancet 373: 1111, 2009)

CONJUNCTIVITIS (JAMA 310: 1721, 2013)

MRSA conjunctivitis

Yutaka Tsutsumi MD

PINGUECULA AND PTERYGIUM

{05932} pinguecula

{21874} pterygium, gross
{21876} pterygium, gross
{21879} pterygium, micro, oil red O stain for lipid

CORNEAL DISEASE

{14127} herpes keratitis
{21931} herpes keratitis
{22055} herpes, inclusion bodies

{22192} red eye from acanthamoeba

Acanthamebic keratitis

Yutaka Tsutsumi MD

{21992} Kayser-Fleischer ring
{21927} band keratopathy, gross
{21928} band keratopathy, micro, calcium dark blue

{21935} granular dystrophy
{21938} granular dystrophy
{21920} lattice dystrophy
{21957} lattice dystrophy, congo red
{21929} macular dystrophy, histology
{21932} macular dystrophy, histology
{22117} corneal transplant
{22121} corneal transplant

UVEAL DISEASE

CMV retinitis in AIDS

Yutaka Tsutsumi MD

CATARACTS

{12428} cataract
{22009} cataract
{22209} cataract
{22212} cataract
{22251} cataract
{22254} cataract; nuclear sclerosis

{21999} ectopia lentis

RETROLENTAL FIBROPLASIA ("retinopathy of prematurity"; Ped. Clin. N.A. 50: 77, 2003)

HYPERTENSIVE AND ARTERIOSCLEROTIC (better, "arteriolosclerotic") RETINOPATHY (Lancet 369: 425, 2007).

{22018} hypertensive retinopathy with hemorrhages

{22034} don't forget diabetic retinopathy, too

RETINITIS PIGMENTOSA

{22074} retinitis pigmentosa

Retinitis pigmentosa
Prize photograph
Institute of Medical Illustrators

RETINAL DETACHMENT

{22080} retinal detachment
{22802} retinal detachment

MACULAR DEGENERATION (Am. J. Med. 121: 279, 2008; Lancet 379: 1728, 2012)

{22059} macular degeneration
{22062} macular degeneration

OPTIC NERVE

GLAUCOMA (Lancet 377: 1367, 2011)

{21990} optic nerve, glaucoma
{21993} optic nerve, glaucoma, micro

EYE TUMORS

{21900} squamous cell carcinoma
{21901} squamous cell carcinoma
{21894} carcinoma in situ, gross
{21898} carcinoma in situ, gross
{21895} carcinoma in situ, micro
{21899} squamous cell carcinoma, microscopic (good pearls)
{19377} amelanotic melanoma of the conjunctiva

Squamous cell carcinoma
Eye pathology site

Melanoma of the Eye
Brazil Pathology Cases
In Portuguese

Conjunctival melanosis
Prize photograph
Institute of Medical Illustrators

Conjunctival melanoma
Prize photograph
Institute of Medical Illustrators

Melanoma of the eye
AFIP
Wikimedia Commons

{22162} melanoma
{22157} melanoma
{22636} melanoma
{22644} melanoma
{21873} melanoma
{21917} melanoma
{21918} melanoma

{22149} retinoblastoma, gross
{22141} retinoblastoma, gross
{22146} retinoblastoma, micro

Retinoblastoma
AFIP
Wikimedia Commons

Flexner "True" Rosette
From a teratoma
Photo by Ed

Retinoblastoma rosettes
AFIP
Wikimedia Commons

Retinoblastoma
Leukocoria
Wikimedia Commons

Basal cell carcinoma
Eye pathology site

{21862} sebaceous carcinoma
{21864} sebaceous carcinoma
{21865} sebaceous carcinoma, oil-red O stain (sebum)

{22101} optic nerve glioma (astrocytoma)
{22113} rhabdomyosarcoma
{22114} rhabdomyosarcoma
{22115} rhabdomyosarcoma

* Blinding of enemies, individually or en masse, is an unpleasant fact of history. They would be removed either with sharp instrument or red-hot iron. Review: Doc. Ophth. 74: 119, 1990. Future major ground wars may make use of weapons that blind the enemy soldiers by combat troops or snipers. The weapons are already in existence and work well. They were banned by the "Protocol on Blinding Laser Weapons" treaty of 1980. Blinded soldiers require more care than dead people, and blinding is demoralizing to military and civilians alike (Br. Med. J. 315: 1392, 1997). You can get a powerful laser that looks just like a classroom pointer on the internet but can burst balloons and blind you (NEJM 363: 1089, 2010). In lawless eras, blinding one's political enemies and prisoners of war (sometimes en masse) was fairly common, and was considered a humane alternative to simply killing them. Of course, sending thousands of blinded soldiers back to their homes is worse for the enemy's economy, too.
Rembrandt, "The Blinding of Samson"

* In the African kleptocracies, many children are confined to "charitable institutions for the blind" simply because they are myopic and do not have glasses (Med. J. Aust. 167: 351, 1997). I leave you to figure out the dark and corrupt politics responsible for this travesty.

* Future pathologists: When the heart stops, intraocular pressure (which largely results from arterial pressure) drops by about half, and pressure continues to drop over the following hours, imparting the softness and deformability to the eyes of the dead.

* For your reading enjoyment: Blindness is a perennial symbol for spiritual darkness. See Oedipus the King, and the Christian scriptures ("Light of the body", "Blind leading the blind"), Shakespeare's King Lear, Goethe's Faust (at the end), Robert Lewis Stevenson's Treasure Island (Blind Pew), Yeats's "On Baile's Strand" & "The Cat and the Moon", hymn "Amazing Grace", "The Blind Men and the Elephant" (re-read that last verse), cartoon "Mr. Magoo's Christmas Carol" (Scrooge isn't a bad man, he's a blind man), others. For the opposite view, see John Milton's sonnet "On His Blindness", and Paradise Lost Book III vv. 1 ff.; Ibsen's Solveig ("Peer Gynt") is blind to Peer's faults, which is how Peer eventually discovers his "real self"; the Mountain King ("In the Hall of the") offers Peer eye surgery so that he will see ugly ("Be selfish") as beautiful ("Be yourself"). Mr. Magoo's Christmas Carol

Thelaziasis, the eye worm
Advanced students
Yutaka Tsutsumi MD

Goya, Blind Guitarist detail
Goya, "The Blind Guitarist"

*SLICE OF LIFE REVIEW

1021-1040, 1042-1044 retina
{15065} eye, human
{15066} eye, human
{15067} iris and lens, normal
{15067} iris and lens, normal
{15068} iris and lens, normal
{15068} iris and lens, normal
{15069} ciliary body, normal
{15069} ciliary body, normal
{15070} ciliary body, normal
{15070} ciliary body, normal
{15071} retina (cross section), normal
{15071} retina (cross section), normal
{15072} retina (cross section), normal
{15072} retina (cross section), normal
{15073} photoreceptor cells, normal
{15073} photoreceptor cells, normal
{15074} photoreceptor cells, normal
{15074} photoreceptor cells, normal
{15075} fovea, normal
{15075} fovea, normal
{15076} fovea, normal
{15076} fovea, normal
{15083} lens and iris, normal
{15083} lens and iris, normal
{15084} lens and iris, normal
{15084} lens and iris, normal
{15312} meibomian gland, normal
{15312} meibomian gland, normal
{20715} ciliary process, normal eye
{20716} optic nerve head and retina, normal
{21802} eye, normal anatomy
{21804} eye, normal anatomy
{21805} eye, normal anatomy
{21806} eyelid, normal anatomy
{21808} eyelid, normal anatomy
{21812} eye, normal eye
{21821} anterior chamber angle, normal ant. chamber angle
{21828} canal of schlemm, normal
{21830} canal of schlemm, normal
{21836} cornea, normal cornea
{21839} cornea, normal cornea
{21842} cornea, normal
{21845} limbus, normal limbus
{21860} fundus, normal optic disk and macula
{21863} fundus, normal optic disk and macula
{21869} optic disc, normal
{21872} optic disc, normal
{21881} retina, normal retina
{21884} retina, normal retina
{21905} lens, normal human lens
{21908} zonular fibers of lens, normal zonules attaching to lens
{21909} melanosis, primary acquired
{21914} cornea, normal cornea
{21916} cornea, normal cornea
{21922} cornea, normal anatomy
{21924} cornea, normal anatomy
{21925} cornea, normal anatomy
{21974} glaucoma, normal anterior chamber ingle
{21976} glaucoma, normal anterior chamber angle
{21977} glaucoma, normal anterior chamber angle
{21996} lens, normal anatomy
{21997} lens, normal anatomy
{22014} retina, normal
{22015} retina, normal
{22017} retina, normal
{22083} optic nerve, normal anatomy
{22391} retina, normal
{22403} fundus, normal eye
{22418} optic disc, normal
{22535} choroid of eye, normal
{23144} fundus, normal
{46438} ciliary body, normal
{46515} diabetic retinopathy, norma

BIBLIOGRAPHY / FURTHER READING

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Teaching Pathology

Pathological Chess


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