Eye
Globe
Grossing globe

Author: Nat Pernick, M.D. (see Authors page)

Revised: 9 May 2018, last major update February 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Grossing globe

Cite this page: Pernick, N. Globe: grossing globe. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyeglobegrossing.html. Accessed June 22nd, 2018.
Describing globe
    • Measure dimensions of the eye (anterior-posterior, horizontal, vertical)
    • Measure length and diameter of optic nerve
    • Measure cornea in mm (horizontal and vertical and anterioposterior)
    • Look for sites of trauma (accidental or surgical)
    • Examine eye surface for gross evidence of extraocular extension of tumor
  • Describe the following:
    • Corneal clarity
    • Shape and diameter of pupil
    • Color of iris, lesions
    • Presence of lens
    • Anterior chamber depth, configuration of anterior chamber angle
    • Condition of ciliary body, lens, choroid, retina, vitreous body, optic disc
    • Presence of foreign bodies (in traumatic specimens)
    • For tumors, describe location, dimensions, shape, ulceration, color, consistency, hemorrhage, necrosis, calcification, ocular structures involved, extension into optic nerve, tumor distance to optic nerve and limbus, rupture of Bruch membrane
    • Transillumination findings
Grossing globe
  • Enucleation: globe and part of optic nerve are removed from orbit
  • For retinoblastoma, may need fresh tissue for genetic studies:
    • Identify tumor location by transillumination
    • Submit optic nerve margin separately before cut into globe
    • Cut small window in sclera overlying tumor and obtain small tumor sample
    • Try to avoid seeding of tumor cells onto optic nerve or elsewhere
  • Fix in formalin (300 ml of 10% neutral buffered formalin) for 24 - 48 hours before sectioning
  • Do not open or puncture the eye
  • Wash in running tap water for 5 - 15 minutes
  • Optionally place in 60 - 70% ethyl alcohol for 1 - 2 hours (firms up eye and restores color of vessels)
  • Review clinical history and results of ophthalmologic examination prior to sectioning
  • "Temporal" is same as lateral; "nasal" is same as medial
  • Orient globe based on:
    • Cornea is wider than tall by 1 mm
    • Optic nerve distance to limbus (junction of cornea and sclera) is less medially than laterally (i.e. optic nerve is medial (nasal) to posterior pole)
    • Superior oblique muscle tendon inserts in upper outer quadrant of posterior globe behind superior rectus muscle insertion and insertion points towards anterior nasal eye
    • Inferior oblique muscle has muscular insertion in lower outer (temporal) quadrant of sclera and fibers run posteriorly and medially
    • Long posterior ciliary arteries are in horizontal plane
    • Four vortex veins exit posterior sclera
  • Transilluminate globe to find tumor and cut accordingly
    • Can use a substage microscope lamp in a dark room
    • Rotate globe over light, mark abnormal shadows on sclera with indelible pencil
  • Take Xray before opening globe if foreign body or retinoblastoma is suspected
  • If choroidal melanoma is suspected, sample at least one vortex vein from each of four quadrants and submit separately
  • Central section is called "pupil-optic nerve" section; other fragments are called calottes
  • Try to include optic nerve, pupil, cornea, lens and large cut surface of tumor in same section, about 8 mm thick
  • Use sharp razor to cut, holding globe with nondominant hand, cornea down against cutting block using blade between thumb and middle finger of dominant hand
  • Open eye with sawing motion from back (adjacent to optic nerve) to front (1 mm inside limbus through peripheral cornea)
  • If no tumor, cut globe at superior and inferior edges of iris in horizontal plane from back to front (5 mm above and below the optic nerve, missing the lens)
  • Quick freeze first in liquid nitrogen to minimize artifacts
  • Obtain cross section of optic nerve
Drawings

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Landmarks of right globe

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Sectioning the globe