Confirm the specimen laterality, and orient the eye anatomic landmarks:
The superior oblique muscle inserts superior to and temporal to the optic nerve; it has a tendinous insertion into the sclera.
The inferior oblique muscle inserts on the temporal side of the optic nerve; it has a muscular insertion into the sclera.
The long posterior ciliary vessels run horizontally; the nasal one is usually more prominent than the temporal one.
The optic nerve is just nasal to the posterior part of the globe; therefore, the distance between the optic nerve and the limbus is shorter on the nasal side.
The cornea has a slightly longer horizontal measurement than vertical (may not be true in children).
Measure the specimen (three dimensions, specifying superior to inferior, medial to lateral, and anterior to posterior) and note its overall shape (round, ovoid, irregular).
Measure the optic nerve stump (length and diameter).
Measure the cornea (two dimensions, specifying horizontal and vertical) and pupil (diameter).
Examine the external surface of the specimen:
Cornea: measure and describe any focal lesions.
Iris: describe the color.
Sclera: measure and describe any focal lesions.
Do not incise the specimen until it has spent at least 24 hours in formalin unless it contains tumor, in which case it may be opened prior to fixation.
Transilluminate the globe by shining a light behind it in a dark room. Be sure to examine the entire globe in this manner. Use a pen to mark on the sclera any transillumination defects and measure them. Describe location of defects by o’clock position and distance to the limbus or optic nerve.
If there is a history of an intraocular foreign body or if calcium or bone is suspected, x-ray the globe prior to opening. If significant calcium/bone is present, decalcify the globe before sectioning.
If tumor is suspected, ink the optic nerve resection margin and take a complete cross-section.
Determine the optimal plane of section. The majority of globes are sectioned in the horizontal plane so that the macula will be included in the sections. The presence of abnormalities such as iridectomy, scar, tumor, or transillumination defect may dictate a different plane of section, so as to include the lesion in the sections.
Incise the globe into two parts using a new razor blade, beginning the cut posteriorly and ending anteriorly. Divide each half into two pieces by placing the cut surface face down on the cutting board and incising in the same plane. There should be four slices of approximately equal thickness.
Examine each slice under the dissecting microscope. Measure the corneal thickness and depth of the anterior chamber. Note the appearance of each component (cornea, anterior chamber, iris, ciliary body, lens, vitreous body, choroids, retina, optic nerve disc) and describe and measure any abnormalities.
Dictation Template #1: Tumor or Other (except glaucoma with reservoir)
Received without fixative/in formalin, labeled _____ and “_____”, is an enucleated left/right eyeball measuring __ cm from superior to inferior, __ cm from medial to lateral, and __ cm from anterior to posterior. The optic nerve stump measures __ cm in diameter and __ cm in length. The globe is round/globoid/irregular. The cornea is __ cm horizontally and __ cm vertically. The pupil has a diameter of __ cm, and the iris is _____ (color). The sclera is white/pale yellow/other color. There is a laceration measuring __ cm in length on the _____. Transillumination demonstrates a __ x __ cm defect located __ cm from the limbus/optic nerve nasally/laterally/inferiorly/superiorly at the __ o’clock position. The specimen is sectioned in the horizontal/vertical/oblique (nasal incision is directed superiorly/inferiorly) plane. There is a mass/nodule/scar/blood clot/other lesion located _____, measuring __ cm at its base and __ cm in elevation. The mass/nodule is _____ (color/pigmentation, consistency) and infiltrates the _____. It is __ cm from the optic nerve margin. The corneal thickness is __ cm, and the anterior chamber has a depth of __ cm. The iris and ciliary body are intact/partially detached. The lens is native/artificial and transparent/opaque. The vitreous body is _____ (color) and ______ (consistency). The choroid and retina are attached/partially detached and _____ (color). The optic disc is flat/bulging/color. The optic nerve resection margin is inked _____. Representatively submitted as follows:
#__ = pupil-optic nerve section
#__ = optic nerve resection margin, en face
#__ & #__ = entire mass with adjacent _____
#__ = laceration
__ blocks, __ H&E
Dictation Template #2: Glaucoma with Reservoir
Received in formalin labeled with patient’s name and "_____" is a firm left/right eye measuring ___ x __ x __ mm. The optic nerve is cut flush with the globe. The opaque, black cornea measures __ x __ mm and obstructs the pupil. There are two glaucoma filtration reservoirs located temporally and medially. The medial reservoir is situated __ mm posterior to the limbus at the __ o'clock position and measures __ mm in length by ___ mm vertically by ___ mm thick. A tube extends from the reservoir into the limbus over a rectangular scleral patch graft measuring ___ mm vertically by ___ mm horizontally. The lateral reservoir is situated ___ mm posterior to the limbus at the ___ o'clock position and measures ___ mm in length by ___ mm vertically by ___ mm thick. A tube also extends from this reservoir into the limbus over a rectangular scleral patch graft. The globe is sectioned horizontally to reveal a detached retina. Representatively submitted as follows:
# __ = horizontal section plus a cross section of optic nerve; 2 pieces.