 And so Lisbon is a city of hills you know it's on this huge river they call it it's really an inlet from the Atlantic Ocean but it's on this huge inlet and it's got it's got hills all over this is the the Castillo that used to guard the entranceway to this river in the you know the Middle Ages and so that's one big hill and then there's another hill here and then this is a hill where people will go and they sit there's little places to have your you know your sangria whatever it is that you drink and then look at look out at the city itself so this is Lisbon from one of the famous hills and this is just looking the other direction it's an interesting mix they've kept a lot of the old city around but yet at the same time modernized it and that's always a trick is to keep some of the old character of a city and yet at the same time modernize it and so you can see that there's modern stores here and there's a street right along here that has you know Gucci and Prada and all the you know all the expensive stores on there and so but there's still a lot of the old town here as you're coming up especially up to the top of the big hills they kept a lot of the old town intact and then again this is looking toward the inlet the quote river they call it and you can see that there's big freighters and ships come through you can also take cruises on there too but I'm not sure really what you see because there's not a whole lot to see on there okay so we're going to talk about is we're going to talk about just general pathology in terms of the eye and also some inflammation and some of the just things that you'll need to know before we proceed on and so whenever we're talking about the eye it's very important that we have that we have an understanding of where the eye comes from and so embryologically there are different parts of the eye that come from different layers and they will help to explain some of the diseases that affect the eyes so it's important that you understand the embryology and what's interesting is when you look at an embryo especially the first four to six weeks of a mouse a chicken a human they all look exactly the same and so they very much look the same so these are embryos actually of mouse eyes but one of the important things that you want to realize is that early on this is the embryo and this is the layer we're going to look at the eye will start by forming an out pouching of the neuro ectoderm all right so neuro ectoderm the same thing that forms the brain that forms the neural tube is what forms a lot of the important parts of the eyes of neuro ectoderm now when you look at the pathogenesis of how the eye starts basically a four weeks gestation this neural ectoderm will pooch out from the side of the developing embryo as it approaches the surface ectoderm it will induce a change and the surface ectoderm will start to indent here and this neural ectoderm will thicken and then eventually that surface ectoderm will push in and form the lens and then the neuro ectoderm will form the other you know neural structures of the eye itself so if you think about it that is coming out and think about it as a big balloon and then somebody takes a fist and pushes it into that balloon and it forms a bilayer cup and so when you look at this it forms this bilayer cup right here and that's the neuro ectoderm all right this just shows you know what what comes from the neuro ectoderm the first and most important part is that that inner neuro ectoderm forms the entire retina so out of that single layer comes the entire retina all the layers of the retina that you guys are going to know about as we go through these lecture series and so that inner layers what forms the entire layer of the retina now the other thing that's important is while this is going on you have to get blood in there you have to get nutrients in there you have to get materials in there to help this rapidly growing eye as it's forming and so what will happen is you'll have a little fissure right here inferiorly and in this fissure comes the hyalurid artery so the hyalurid artery comes in and the hyalurid artery branches out all the way around the lens itself and provides nourishment to that forming embryological eye but it has a fissure where it goes in and that's important because when that fissure closes off eventually when that becomes a globe itself there can be problems with the fissure closing that can lead to congenital anomalies so again an understanding of the embryology will let you know why these congenital anomalies occur all right so here's the first one Lee what do we see in here okay and what do you think that represents exactly and so when you think about this it starts at the equator and it's almost like a two-sided zipper that zips anteriorly and posteriorly and so it's very rare to see a coloboma at the equator but the anterior and posterior aspects of where that fissure closes decide where colobomas are formed so the anterior part of that fissure that stays open leads to a coloboma and you see it's got that inferior location to a little bit inferior temporal and that just lines up with where that fissure is and so that forms an iris coloboma okay what does coloboma mean sorry huh in promo language from the Greek of course okay all right what are we looking at here Nathan all right so again we you know when you're when you're looking at something you're not sure what it is put it in the context of what we're talking about so since we just showed an anterior part where the fissure doesn't fuse obviously the next thing I'm going to show is a posterior part why because I'm OCD and I go from step A to step B and so this is now the posterior equivalent of that corridor fissure not closing so this is what we call an optic nerve coloboma now sometimes it doesn't go all the way to the optic nerve itself but again it's inferior here and basically what you're looking at is just bare sclera and so when that fissure doesn't close off the retina doesn't form the corae doesn't form and you end up with just a big piece of sclera sitting there so this is called an optic nerve coloboma so kind of the posterior extent when that fissure does not fuse so posterior optic nerve coloboma now other parts of of the eye come from different layers also so we said that when the neuro ectoderm poaches out and then hits the surface ectoderm you end up getting an imagination of that surface ectoderm and that's what forms the crystalline lens so the crystalline lens is actually comes from surface ectoderm so it's different than other parts of the eye so when you look at it you'll see again you'll get this invagination and eventually that surface ectoderm will pinch off and you'll get a cyst and then the cells from the back will grow forward and fill up that cystic cavity and make that solid lens and this is important to understand how the lens develops throughout life so when those cells leave that posterior part of the lens capsule and grow forward after that time you normally do not have lens epithelial cells on the posterior surface and so if you look right here this is the way you remember them they grow and they go forward so when the lens is growing throughout life those lens epithelial cells that sit under the anterior lens capsule go around to the equator and then they fan out and throughout life they send their fibers anteriorly and posteriorly but they do not extend along the posterior capsule so that's why you don't normally have lens epithelial cells on the posterior capsule if you see them there that's an abnormal situation and here we just show you that again these cells come around to the equator they fan out in the equator and they send fibers both anteriorly and posteriorly you can see the fibers here in the cmv and so you normally do not have those fibers posteriorly in the lens as it grows and this just shows again in the mouth side which is exactly the same as a human eye that surface ectoderm comes out I'm sorry the neuro ectoderm poaches out it meets the surface ectoderm the surface ectoderm pinches off and when it does that it causes that neuro ectoderm to invaginate and leaving you a two-layered structure all right now josh that neuro ectoderm has now pinched off it's a bilayered structure there what parts of the eye does that neuro ectoderm form we start anteriorly what part would this form up here sound the iris pigment epithelium okay good so the iris pigment epithelium how do we tell that from pigment epithelium and other parts of the eye what's the difference both layers exactly so both of those layers on that posterior iris pigment epithelium come from those two layers of that neuro ectoderm and they're both pigmented all right Tara the inner the intermediate layer what does that form not quite the intermediate not the posterior it forms the ciliary body epithelium okay so the anterior part of that forms both layers of the iris pigment epithelium and they're both pigmented it also forms the two layers of the ciliary body epithelium and how do we tell the difference between ciliary body epithelium and iris pigment epithelium okay which one is pigmented and which one's not so here's how you remember it the outer layer is the pigmented layer why because it's continuous with the rpe which is also pigmented so the outer layer is pigmented the inner layer of the ciliary body is not pigmented and if you follow it all the way out to you know to the retina it's continuous with the retina and so the outer layer is pigmented and then that's continuous all the way back posteriorly to the pigment epithelium and then the inner layer is non pigmented it's continuous with the retina and remember the retina all forms from that one inner layer now in terms of the the hyaloid artery we talked a little bit about what the hyaloid artery does is it provides nutrients through the anterior part of the eye especially the lens and in fact the hyaloid artery will form a whole net of blood vessels around the lens and they call it the tunica vasculosa lentis basically a vascular tunic the vascular collar around the lens and then as the eye forms this will regrets now there are some pathologic settings where it doesn't regrets and we ended up getting a remnant and so nico what do we see in here all right so you can see you've got this stock here and it's coming forward and there's the tunica vasculosa lentis now by this stage in in a development of an embryo this should all have regrets and so in this particular eye it didn't and so sometimes you'll see remnants of the hyaloid artery when you look into the eye even in an adult and when you look anteriorly this is the lens right here this is posterior to the lens look at those little vessels there so this is not regressed these little vessels are still here behind that that chrysaline lens all right so we we wanted to talk so on your embryology you know realize what layers different parts of the eye come from so neuro ectoderm gives you your pigment epithelium of the iris your epithelium of the ciliary body your rp and your entire retina surface ectoderm gives you your crystalline lens also gives you the epithelium of the lids of the conch of the cornea now the in-between structures of the eye what they used to call mesoderm you know we were taught that that comes from the mesoderm layer the middle layer but as people did studies about 40 years ago and look more carefully at this they found that it's actually neural crests so when you think of the tissue in the inside the eye that you think of as mesoderm it's actually neural crests all right so i want to talk a little bit about inflammation this is a slide i copied this from an old talk this has got to be a fake slide because i've never seen a blood smear with all these blood cells on it so it's got to be a fake so this is a cnn slide you know fake slide come on this morning wake up wake up here come on okay all right so this has got pretty much every you know type of of white blood cell and red blood cell for that matter on here so chris what kind of cell are we looking at right here the neutrophil neutrophil and what's another name for a neutrophil or full name for a neutrophil pma so polymorpho neutrophil so it's the way you tell it is it's got multiple you know nuclei in it so it's got this several nuclei in it pmn and that's kind of your standard inflammatory cell all right so we've got some other inflammatory cells in here back out this one's got kind of a bi-load little heart-shaped nucleus what is this cell and what makes you say it's an eosinophil exactly so it's got all of those little eosinophilic granules if you will and so it's got granules that are in there so this is an eosinophil people think of this as my maybe a specialized pmn or off branch of a pmn all right now we've got another cell here which i've never seen in a path smear and so i guess interns are you guys are pimple ball now what is that cell right there so that looks like a basophil it's a basophil and again i've never seen a basophil in an ice smear i mean i'm sure they're one somewhere but you just don't see them these eventually give rise to the tissue mast cells all right now there's another one right here let's see shrob you're hiding back there what do we have here okay so this is a lymphocyte and then right Tina what are those right there platelets and then lastly we've got the red blood cells so that's kind of a nice overview of a fake slide that's got all kinds of cells in i don't know how they did that so let's talk about pmn's let's go back yes we've swung back your lead what do pmn's do all right so these are kind of the cells that defend everything i mean they kill foreign material they kill bacteria they kill things that are coming in and what's important to remember about these pmn's is they have granules within them and these granules have materials in them that help to kill off foreign material the second thing though is there's a lot of substances in there that attract other kind of cells and so these are the cells that go in you infection you've got a something in there they go in they dump out their toxic contents they kill it and eventually they call in macrophages and other cells that come in and eat up kind of the you know the the dogs of war that are left over there so the problem with these is if you've got something in your skin you know the pmn's come in they kill it you know it eventually scars over and it's fine that doesn't cause any problems you got this in your cornea these can cause direct damage so as these cells fill their contents there's proteases in there there's collagenases in there and so these can cause real havoc in a cornea they can lead to a cornea melt they can lead to scarring and so that's why treating for example a bacterial corneal ulcer is such an ophthalmic emergency all right what do we have cinnophils do nice all right so kind of the thing you want to remember about eosinophils is they tend to attack parasites so when you see a whole bunch of eosinophils you're usually thinking of some kind of a parasitic infection and well this doesn't really show it but these are supposedly eosinophils you know again i don't see those much an ophthalmology but usually they're a sign of a parasitic infection all right josh what do lymphocytes do some more chronic responses to for not bacteria viruses okay so they're more of a chronic response not so much a an acute response so we call chronic inflammatory cells so they're involved in a chronic immune reaction what different types of lymphocytes are there roughly i mean just in the broad terms exactly you can have t lymphocytes and those can be subdivided into all kinds of cells you know killers assist cells helper cells and b cells and how are b cells a little different than t cells they're cell mediated so they act a little different than t helper cells well the other thing is what do b lymphocytes eventually form plasma cells which make antibodies antibodies exactly so that's how you remember them and so when you look at them plasma cells are a specialized lymphocyte and there's a couple of ways that you can recognize them the nucleus is often off to the side so it's an eccentric nucleus and then it takes up about a third of the cell and then the cytoplasm takes up the other two thirds the other thing that's interesting is it's got this clump chromatin and people call this a wagon wheel so you know those old wagon wheels you saw that you know the wagons coming across the prairie they had the central axilin and the spokes coming out that's kind of what these look like and so you see this wagon wheel clumping basically these become antibody factories they start making antibodies to you know to defend against various pathogens and eventually when they start making so many antibodies they just get so swollen that they spit the nucleus out and they become a bag of antibodies they call this a Russell body so this is a sign of a really chronic ongoing smoldering inflammation and eventually you get what's called a Russell body all right let's see Tara what are these monocytes do all right so a monocyte is in the blood but once it gets out of the blood into the tissue then it becomes a macrophage and if you want to sound intelligent you say it with a British accent so you see you say macrophage and so it always sounds more intelligent if you if you say it with a British accent so and now here again I'm going to insult people I'm going to create you know hostile work environment as opposed to a southern accent which you know you can be a a Nobel Prize winner but if you say y'all after it it just doesn't really sound really cool but British you could be saying anything you could be saying the dumbest thing ever but if you say it with a British accent it just sounds so intelligent so if you really want to impress them you say macrophage and and I haven't figured out where centimeters comes from either that's the other one it's it's three centimeters I went what is that is that British is a franchise I don't know what something you need so when it becomes a macrophage it means that it's extended into the tissue and remember macrophages are kind of the cleanup cells and so they'll come in and they'll kind of clean up what's going on and try to help the initial part of the repair mechanism of the healing mechanism so they come from a blood-derived monocyte and then eventually go into the tissue and become a macrophage all right so this just shows you as the macrophages go out into the tissue they're these cells that have these bigger nuclei and they've got this pinker cytoplasm around so those are tissue macrophages all right now there are some specialized macrophages and eventually they go further down they become epithelioid cells and then they can become giant cells so Nico tell us what the three types of giant cells are lime hand cell, giant cell, and two tonne giant cell okay exactly so I probably should take these you know off here because I mean it's obviously telling me what it is so the lame on styled giant cell is what you think of as a giant cell I mean that's when you think about as a giant cell and it has the nuclei lining up around the periphery kind of in a horseshoe and it's got the cytoplasm all coming in the center and so a good example where you see these in the eye most commonly is something like a chelazion so this is a sign of a granulomatous inflammation when you see giant cells and this is just another tissue view showing you these langhans type giant cells they've got lining up of the nuclei in the periphery now this is the second type form body giant cell and obviously it's well named because it takes care of foreign objects and so inside the eye you can see these for example around a suture so you've got a suture in there chronically they'll often have these little multi-nucleated giant cells around them if you look at a foreign material in the orbit for example you got a piece of tree branch in your orbit you'll often get these foreign body giant cells forming around them and they're different from the other giant cells and that they have these nuclei all jumbled up so that's how you can tell it's a foreign body giant cell and here you see this is a suture and look at this giant cell just kind of cupping around it so it's almost like it just kind of surrounds this foreign material tries to you know if it can't eat it at least tries to wall it off and then lastly two ton giant cells these are really interesting Chris what does what the heck is a two ton giant cell all right so two ton giant cell they're interesting because you have these round nuclei here but you have this rim of this empty space and so that is lipid so these two ton giant cells are really interesting because they have this rim of this lipid that's around them can you name one entity that we would see a two ton giant cell in there's a specific entity we often see these in in kids exactly so you see these two ton giant cells in juvenile xanthogranuloma you can often you can see them in adults too sometimes you get these lipogranulomatous inflammations in an adult you can see those so the key is they've got this this rim of lipid surrounding them so it's like they've almost got a halo around them so very specialized type of giant cell now just like there are three yes no usually example asthmus are interesting they're usually macrophages stuff with lipid and so a little bit different so you've got three types of giant cells remember those you've got three main types of granulomatous inflammation and so when you think of a granulomatous inflammation the first type is a diffuse granulomatous inflammation and the example around the eye that we use of a diffuse granulomatous inflammation is sympathetic ophthalmia so beca what is sympathetic ophthalmia okay so sympathetic ophthalmia it's just what it says it's an inflammation that occurs in sympathy to a severe trauma to an eye so usually don't see them just with a minor trauma but in a severe trauma you will start to get an immune reaction and then people have argued is it a reaction to uvial antigens is a reaction of pigment in the eye whatever it is that triggers it then you can get a reaction to the other eye and this was really first seen in world war one where you had you know generals trained in the 19th century of you know cavalry charges and people running across open fields against 20th century weapons such as machine guns and so patients in world war one would get these nasty shrapnel injuries in one eye and then they would go blind in the other eye from sympathetic ophthalmia you know now we've realized that if you've got a severely traumatized eye you can prevent sympathetic ophthalmia by nucleating the eye within the first you know 10 to 14 days but we've also got immune medicines now that can treat it now I'm trying to think pathologically I don't think I've seen a sympathetic ophthalmia in years so very uncommon entity but it is a good example of a diffuse granulomotus inflammation and here you can see a different kind of granulomotus inflammation I didn't write this down so what's the second type of granulomotus inflammation um so you could have non-caseating which this is what this looks like okay so what do we call the broad category of these the second type of granulomotus inflammation it's called a nodular type and the example that you are getting at is what disease is characteristic of this sarcois exactly so people will call this a nodular or sarcoidal type of reaction so you get these multiple nodules of inflammatory reaction and if you look right here you'll see that they do kind of form these nodules and you've got these really bizarre looking giant giant cells I mean ventae giant cells very very big giant cells so you can see them here and so they're multiple nodules and so this is called a sarcoidal and TB fits in this too although TB sometimes gets caseating gets cheese like it gets rotten in the center of it but this is the the second type a nodular type of granulomotus inflammation this is the sarcoidal type and you can even get these weird asteroid bodies they call them in the center of the giant cells and I don't know that kind of looks like a I don't know a meba to me or an octopus doesn't look like an asteroid but you get these weird inclusions in the center of the giant cells in sarcoid they call them asteroid bodies so that's sarcoidal and then the third type is a focal or zonular type of reaction this you know the characteristic of this in in an eye is when you had a ruptured lens capsule traumatic or whatever and then you get this zon is zonular focal reaction around it pretty uncommon nowadays because we take care of rupture lens capsules we do surgery on eyes that have been traumatized we do good cataract surgery we don't do crude extra caps anymore but um phytoanethylactic endothelitis was an example of of this type of zonular reaction we'll talk about that when we do the pathology of the lens and here you can see this is a patient believe it or not this was the cornea up here and this was iris and silver body this is the lens that's been ruptured because of the severe trauma this poor guy got kicked by a horse so the horse kicked me right there and you can see the lens capsule has been ruptured here's someone's cortical material and when we look yeah when we look closer in here we'll see this focal granulomatous inflammation so those giant cells are in there trying to clean up that ruptured cortical material so three types of giant cells three types of granulomatous inflammation all right now there's no other place to talk about this so when you get an eye that's been kind of severely traumatized it has certain reactions to it that I wanted to chuck in here so shrub what do we see in here we've got an eye that's been cutting half sagittally what do we see inside here yeah it's even like it's almost like crystalline you're even seeing like sparkles when you shine the light in there and certainly you've got a disruption of normal intraocular contents they're all jumbled up and disrupted so this eye has been severely injured and when we look at it pathologically now you mentioned here's the thick square, the square is really thick look at the shape that's almost square instead of round what does that tell you all right so this eye is tisical so tisospobae by the way spelled with a ph-th so this is tisospobae so tisospobae is an end-stage reaction to some kind of either severe insult either a trauma severe inflammation whatever it is kind of the end result of an eye that's been so traumatized that it shuts down so the first thing you get is is you notice that the eye becomes square instead of round and the square becomes real thick that's a sign of hypotenuse so if you take the pressure intraocular pressure on an eye that is is gone into tisus it will be zero or certainly very low and if you look right here in the coroid and the ciliary body look at how thick that is it's spongy it's because that pressure's not pushing things out so it's like the sponges absorb water and even gets thicker so you see that this coroid gets really thick and spongy look at the disruption of intraocular content so intraocular contents are not normal they're very disrupted in an eye that's tisical here you can see the thick sclera because the eye has hypotenuse sclera kicks on fluid it gets really thick and here you see the edema of the coroid you know it's the pressure zero I said it's almost like a sponge that sucks up water it gets really thick it you know what else can you see in severe tisus what are we seeing right here this is actually this would be optic nerve back here and the retina is completely gone here so this is a long where the rpe used to be here's a close-up it's even more than calcium what is that what kind of tissue is that you can be on that bone exactly so when you get an eye in the end stage such as tisus bovine the retinal pigment epithelium is a pluripotential cell it can make all kinds of other cells so it can become like a fibroblast like an astrocyte but when it is stimulated enough it could start laying down bone and so my technician Mary hates these because when she goes to cut these tisical eyes she has her nice sharp care you know her nice sharp blade and it goes hits hits bone so she even has to decalcify these sometimes in order to cut them and so you'll get along the rpe in the end stage bone this is actually bone right here so that's just the end stage reaction of an eye that's been severely injured or inflamed or whatever so tisus bovine all right now well i've got you all here this is the only other time i can do this this part of the lecture also one of the things that that i love here's a patellism that's a real bugbear to me is the i love that bugbear is when we get a specimen from the or without any information or without what you're looking for so remember it's the old thing about garbage in garbage out if i don't know what you're thinking and what you want i can't do the special stains or what you need to help and so eventually you guys are going to be seniors in the or you're going to be sending specimens you're going to be working with people i need to know what the history is and what you're looking for so it doesn't do me any good when i get a specimen that says lid you know we want to know okay recurrent ulcerative lesion rule out basal cell or possible sebaceous cell or something and so we need to know what you're looking for in order to help guide us to do the special stains that we need to do to help you so if you are in the or and you're planning on doing something special call us ahead of time by us i mean the fellows to or marry or me call us and let us know what you're planning to do and we can guide you sometimes there's a setting where we'll need fresh tissue where there's a setting where we'll need a special fixative but we need to know that ahead of time it doesn't help us after the tissue is already in form alone and so communication is the key if you're going to do a biopsy and you want something special done let us know and that's really important now the first thing is the requisition slip who usually fills that out it's usually the nurse who fills that out but i find that the more information we get on a requisition slip better we can help you to get the information you need and this is where i really credit dr patel he writes on there himself he'll put on their nick check with a non-healing lesion will i be c e tabby okay so that's helpful to me or he'll draw a picture he'll say okay lesion here pigment here and that helps us to align the specimen and to figure out what we're looking at so especially if you're looking at a tumor you want us to look at margins things like that give us the information we need on the requisition formula we can help give you what you're looking for now when you're doing ocular tissue itself this goes without say but you really want to be delicate on there so every once in a while we'll be looking at a past specimen we'll see all this purple mush on there and that's what we call crush artifact so if you grab it really tight with a forcep and crush it we can't tell what that tissue is so be delicate and if you're looking at something abnormal and you want us to compare to something normal get a rim of normal around it if you can that's always really helpful for us to see that and then make sure it gets fixated promptly don't let it sit out for you know the weekend overnight before it goes into fixative because then the tissue breaks down now the most common fixative we use is just 10 percent neutral buffer formula and that is the vast majority of specimens however if you want electron microscopy which is rare nowadays it won't do much em but that has to have a glutaraldehydes based fixative so if you're going to do em on a specimen again let us know ahead of time if you need fresh tissue or stains that require fresh tissue let us know because we need to freeze that ahead of time and so we can do that fresh so when we put the specimens and you want to say you have a fresh tissue you say okay i want this done fresh don't just put it in the jar dry don't put it in a jar filled with saline because it'll get all macerated what you do is you put some saline on a four by four on the wexel or whatever to moisten it and then put the tissue on that and then put that in the in the jar now say you guys are finished with your residency and you're going out and you just started your practice in mazula montana so that you can you know cross-country ski and you decide you're going to send me a specimen you can actually put the specimen on ice in the chest and send it FedEx and it'll keep it good for 24 hours but the key is put it on a saline salt gauze don't put it in a jar of saline don't put it on a dry gauze put it on a moisten gauze and then close the container and then put that on ice now conjugal is a special material if you take off a piece of conjugal it rolls up into a ball so if we're concerned about a tumor of the conch we really want that to be laid out so that we can look at the margins and look at the edges and not make it roll up like a ball so what i find is is you know the little cardboard on your gowns when you spin your gowns that's perfect so if you want to do a conjugal specimen take that cardboard that you know you spun your gown with cut about a little two by two centimeter piece of it use the non-shiny surface and lay the conch out on that and let it sit there for about a minute and it'll stick and then just float the whole thing in the formula and we'll leave it on there until my tech has a chance to process so when the fellows look at it they'll actually look at it on the cardboard and then we'll run it through processing stuck to the cardboard and you can actually orient the margins by cutting notches in the cardboard so you want to say okay one notches temporal two notches are superior i've seen people try to pin stuff to specimens that doesn't work because the pins fall out i've seen people put just an ink dot on them well the formula dissolves ink so unless you have a special ink that doesn't work so i think this works the best now if you got a piece of lid you can put a tiny suture through it if you want now help us orient it too this is what i'm talking about here's a little piece right here we lay it out onto the surface we let it dry we cut a notch okay this is temporal this is the right eye and we can have my tech cut it through and we can actually assess your margins for you so this is really helpful to us all right a couple of things i want to talk about and what we've done today stains okay let's see we went i think you did who did the last real one okay back to lee now i'm going to do this randomly so you guys can't game up by trying to sit in the back i'm going to start in the back one of these so we've got several different stains we use in ophthalmology and lee what is the most common stain we use this is an example of it h&e exactly so so you know the problem is is you always know the answer to every question except when the spotlight hits you and it's i don't know if it's if it's the stress hormones or what but isn't that spotlight hits you man that iron curtain just goes in your brain stops working lee what's your name so don't worry that's normal the reason i use this format for you guys is you know you're going to have to take oral boards eventually to you know be boarded in ophthalmology and man people's brains shut down when they were questioned so that's why we do this format so this is an h&e stain this is our standard stain hematoxilin eosin so these you remember hematoxilin is blue and eosin is is pink or red so this is our standard stain you think of a histopath stain here's a cornea you've got the epithelium the stroma you've got these blue inflammatory cells here you've got the red blood vessels so this is our standard bread and butter h&e stain we do this on the vast majority of specimens that we get okay Nathan what kind of stain is this yep first of all what kind of tissue are we looking at this is cornea no this is light pink this is dark magenta what stain is this this is pas and what does pas stain for why would i show you this picture of the cornea to talk about this it stains basement membranes and so the reason i'm showing you this if you look this is the corneal epithelium this is bowman's layer non-staining this is the basement membrane of the epithelium staining that bright magenta color so this really highlights the fact that the epithelial basement membrane is not bowman's and bowman's is not the basement membrane so this is a pas stain it stains basement membranes so chance to save yourself what part of the cornea is indeed a basement membrane but decimates exactly so decimates would pick up so this is kind of the second probably most common stain we use the pas staining for basement membrane and another part of the eye that's really thick basement membrane is the lens capsule so if you're looking for lens cap so you can do a pas stain also all right what kind of stain are we looking at right here josh it's a blue one that's man you guys are you guys are on the ball man sharp something in the cornea and the corneal stroma so what do we use that's got blue and corneal stroma it's part of a part of a mnemonic that we memorize when we're looking at corneal stromal dystrophies alchemy blue and what does alchemy blue stain for okay so there's a mnemonic when we're going to do the cornea the cornea dystrophies and don't memorize it now but you will then Marilyn Monroe really always gets her man in l.a california so Marilyn macular Monroe mucopolysaccharide really recessive always alchemy blue so alchemy blue stains for mucopolysaccharide so this is an alchemy blue stain of the cornea staining the mucopolysaccharide so this is a macular dystrophy of the cornea and we'll go over this when we do cornea in about four weeks all right tera so again i'm ocd we're going right down the list here what's next all right so massage trichrome stain and what is it stain all right so granular her hyaline exactly so this is a massage trichrome stain and it stains hyaline material that pinkish color it also stains epithelium pink it stains connective tissue like stroma cornea sclera blue okay and the third one nico congo red and what is it stain amyloid so la california lattice congo red amyloid now this does not happen to be a lattice dystrophy this is actually amyloidosis and so amyloid will stain with congo red and i always tell people maybe you know supposedly males are colorblind which our spouses always tell us as we say oh that's gray they say no that's not so this is actually congo red that doesn't look red to me that looks more orange you know i don't know what do you guys think it looks orange to me rather than red so red orange nectarine okay it's it's nectarine all right so congo red stains amyloid chris what are we selling here gms no this is kind of a weird look here if you look at it it's kind of lit up here almost like it's lining up here exactly this is the other property of amyloid is if you put two polarized filters on there and cross them with the congo red stain you will get birefringent so this is a amyloid this is a lattice dystrophy amyloid in the cornea and we've now crossed the filters and taken a picture so this shows the birefringence that you get becco what kind of stain we see in here okay yeah looks like some yeasty beasties on here so what kind of a stain do we do for those little yeasties gms so it's it you know and the initials you can memorize but but remember what they are gamori methenamine silver so it's a silver stain so it stains the fungi in a silvery color so gms gamori methenamine silver all right what kind of stain is this again we'll pimp our interns here i know you thought you thought you were safe but you're not it looks like we're again staining for some sort of organism uh-huh some silver in there as well you look these kind of round almost cystic looking things and of course there's these regular lamellae of collagen around them so i'll give you a hint this is cornea these are acatamoeba cysts and so the stain we can do just with a normal microscope is called a gridly stain so this is a stain now the reason we use this now acatamoeba lights up with you know fluorescent stains and things but i don't have a fluorescent microscope in my clinic so we can use the gridly stain and the gridly stain will stain the acatamoeba cysts especially and so this is called a gridly stain i just love gridly i mean i gridly should be like the butler in an english movie it's gonna be gridly bring tea yes sir you know tea here you go sir you know so gridly the english butler stain so the gridly stain all right so that stains acatamoeba all right uh straw i guess we're you we're looking at here cornea but blue stain here especially in the base of the epithelium could be iron very good and what does the what is the name of the iron stain prussian blue and how do we remember that prussians exactly so who are the prussians the prussians were the german militarists you know in the in the first world war and so when you think of prussian you think of iron you think of tanks and guns and cannons and things and so prussian blue stains iron and that's how you remember it this just happens to be an iron deposition in the cornea so there are many different iron lines that conform from iron deposition in the cornea so this is prussian blue tina what are we looking at here the deeper part this is the name of a stain that's that describes exactly what it is and this is a fresh frozen piece of tissue okay this is a stain for lipid and it's called oil red oak and the reason you remember it stains oil red little o's and so this are here we go little o's of oil that are stained red and so the problem is is that oil will leach out when you do your normal hemispathologic processing so when you put it in xylene you put it in other things it sucks the oils out of there so on a normal formal and fixed tissue the oil gets sucked out and it leaves empty spaces whereas if you want to do an oil stain you have to have fresh tissue so this happens to be believe it or not just a cornea that had been done years ago we just did this for fun for research this is an arcus semilis but this is just the you know the lipid deposition that forms that purple arcus you get and so oil red oak it stains oil red o's so that's how you remember it oil red oak okay enough of the stage so now here's the castillo again on top of the hill in in lisbon and so you see the old city i mean these are narrow steep streets it's all stacked up in here so we'll go back to that so for some reason i'm not lecturing next tuesday i don't know why but so then tuesday whatever december fifth um lid so read your bcsc book chapter on lid and we'll go over all of the different lid epithologies questions in two minutes okay good so today i talked an awful lot because this was just kind of an intro next monday i'm going to talk a lot less i mean next it's a week from tuesday i'm going to talk a lot less and you guys are going to talk more okay all right very good