CASE 1

Clinical History:

A 62-year-old man resides in the Sunshine State (Trinity Beach, Queensland or Daytona Beach, Florida). He has noted the increasing size of a nodule on his lower eyelid for the past 4 years. His vision is not affected, but the nodule becomes irritated when scratched. He now comes to you for advice regarding this lesion.

Image 1.1

Image 1.2

Questions:

1. What is the name for this mass lesion?
2. How does this lesion occur and how can it be prevented?
3. What is the prognosis with treatment?

CASE 2

Clinical History:

A 49-year-old man has been bothered an enlarging, painful nodule on his upper eyelid for the past three weeks. His vision is not affected.

Gross and Microscopic Pathology:

The appearance of the lesion is shown here grossly (image 2.1). Describe the histologic findings (image 2.2).

Image 2.1

Image 2.2

Questions:

1. What is the diagnosis?
2. How does this lesion occur?

CASE 3

Clinical History:

A 2-year-old child has decreasing vision in the left eye. Pain and tenderness are noted as well. An MRI scan reveals a 2.5 cm mass involving the left posterior orbital region. The left eye is enuclected.

Gross and Microscopic Pathology:

The appearance of the eye is shown here. How would you describe it? The microscopic appearance of the lesion is shown at low power. What features are present? (images 3.1 to 3.3)

Image 3.1

Image 3.2

Image 3.3

Questions:

1. What is the diagnosis?
2. Explain the molecular biology of this lesion.
3. What is the significance of a family history of this condition?
4. What is the prognosis?

CASE 4

Clinical History:

A 62-year-old woman has noted decreasing visual acuity in her peripheral vision over the past year, and she states that "everything just seems to be darker." She goes to her optometrist. The optometrist, using an "air puff" tonometer" discovers that she has increased intraocular pressure bilaterally. The cornea and sclera of each eye appear normal. There is no opacification of the crystalline lens.

Funduscopic and Microscopic Pathology:

The representative funduscopic appearance of her condition is demonstrated in image 4.1, and the microscopic appearance in image 4.2. An unrelated condition involving the same anatomical region is shown in image 4.4.

Image 4.1

Image 4.2

Image 4.3

Image 4.4

Questions:

1. What condition is present? Who is at risk?
2. How is this condition detected?
3. How does this condition occur?
4. How is this condition treated?
5. What is the significance of the condition in image 4.4?
6. For a patient with significant visual impairment who continues to operate a motor vehicle, what should you do?

CASE 5

Clinical History:

A 41-year-old woman has had increasing pain in her right eye over the past day. She says it feels as though something were scratching it. Her vision in that eye is blurred. Her left eye is unaffected. She has had similar episodes in the past.

Funduscopic and Microscopic Pathology:

The funduscopic appearance of the condition is shown in image 5.1)? What is seen microscopically in image 5.2)?

Image 5.1

Image 5.2

Questions:

1. What is the diagnosis?
2. How is this condition treated?
3. What is the prognosis?

CASE 6

Clinical History:

For the past 3 months, a 53-year-old woman has had decreasing vision in her right eye. Today she has experienced sudden loss of vision on the right, as though a window-shade had been pulled down. Funduscopic examination reveals a 13 mm choroidal mass on the right. The left eye appears normal.

Gross and Microscopic Pathology:

The cross section of the enucleated eye is shown here (image 6.1). This is the microscopic appearance of the mass (images 6.2 and 6.3).

Image 6.1

Image 6.2

Image 6.3

Questions:

1. What is the diagnosis?
2. What sudden complication did she have?
3. What is the significance of the histologic appearance of this lesion?

CASE 7

Clinical History:

A 21-year-old woman from Bangladesh has had decreasing vision in her left eye "for years." Physical examination reveals left corneal and conjunctival scarring. Her eyelashes are partly turned in, scratching the surface of the eye. A conjunctival scraping is made for diagnosis.

Microscopic Pathology:

The appearance of the conjunctival scaping with Wright-Giemsa stain is shown in image 7..

Image 7.1

Questions:

1. What is the diagnosis?
2. What are risk factors?
3. What is the treatment?
4. Name another cause for preventable blindness.

CASE 8

Clinical History:

A 62-year-old impoverished man living on a subsistance income has never received regular health care. He participates in a health screening program conducted by medical students and is found to have a random serum glucose of 181 mg/dL. On followup of this, his hemoglobin A1C is 10.3%. Based upon these findings, he is referred for vision testing.

Funduscopic Pathology:

The findings on funsduscopic examination are shown in images 8.1 and 8.2.

Image 8.1

Image 8.2

Questions:

1. What is the diagnosis?
2. What is the pathogenesis?
3. What is the prognosis?