Eye - Inflammation














comment:
With the possible exception of the cornea, ocular inflammation is an uncommon background lesion. It can occur in any of the ocular structures and often present in multiple ocular structures concurrently. Ocular inflammation has a number of causes, including trauma (especially the cornea), chemical irritants, and systemic toxins.Corneal inflammation can be diffuse or localized in particular zones, such as the epithelium or stroma. In addition to the causes listed above, corneal inflammation can also be caused by insufficient tear production, nutritional deficiencies, and infectious agents, such as bacteria, fungi, and viruses. Since the cornea is normally an avascular tissue, stromal neovascularization is a common component of corneal inflammatory lesions. Hyperplasia of the epithelium is also a frequent finding ( Figure 1




Anterior uveal tract (iris and ciliary body) inflammation can result from various causes, such as infectious agents such as bacteria and viruses, and immune-mediated (allergic) reactions. Iridial and ciliary body inflammation ( Figure 7





Vitreal inflammation ( Figure 12


Retrobulbar inflammation ( Figure 14


In NTP studies, there are five standard categories of inflammation: acute, suppurative, chronic, chronic-active, and granulomatous. In acute inflammation, the predominant infiltrating cell is the neutrophil, though fewer macrophages and lymphocytes may also be present. There may also be evidence of edema or hyperemia. The neutrophil is also the predominant infiltrating cell type in suppurative inflammation, however, in suppurative inflammation, the neutrophils are aggregated and many of them are degenerate (suppurative exudate). Cell debris, both from the resident cell populations and infiltrating leukocytes, proteinaceous fluid containing fibrin, fewer macrophages, occasional lymphocytes or plasma cells, and, possibly, an infectious agent may also be present in within the exudate. Grossly, these lesions would be characterized by the presence of pus. In the tissue surrounding the exudate, there may be fibroblasts, fibrous connective tissue, and mixed inflammatory cells, depending on the chronicity of the lesion. Lymphocytes predominate in chronic inflammation. Lymphocytes also predominate in chronic-active inflammation, but in chronic-active inflammation, there are also a significant number of neutrophils. Both lesions may contain macrophages. Granulomatous inflammation is another form of chronic inflammation, but this diagnosis requires the presence of a significant number of aggregated, large, activated macrophages, epithelioid macrophages, or multinucleated giant cells. Inflammation is differentiated from cellular infiltrates by the presence of other changes, such as edema, hemorrhage, degeneration, necrosis, or other evidence of tissue damage.
recommendation:
Inflammation in the eye should be diagnosed and graded whenever present. Inflammation should be diagnosed separately for each ocular structure (e.g., cornea, anterior chamber, iris, ciliary body, retina). The modifier as "retrobulbar" should be used if the inflammation is in the retrobulbar space. An appropriate type modifier (acute, chronic, etc.) should be included in the diagnosis. Two or more subtopographies (e.g., ciliary body and iris) should not be used in the same line-entry diagnosis. Associated lesions, such as fibrosis or neovascularization should not be diagnosed separately, unless warranted by severity, but should be described in the pathology narrative.references:
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Web page last updated on: October 28, 2014