Grossing of Non-neoplastic Globes, Including Fetal Eyes

Grossing and sectioning of fetal and adult globes are critical steps in the histopathologic evaluation of ocular diseases. Proper handling of the globe is essential for accurate diagnosis of conditions such as tumors and non-neoplastic changes, including trauma, infections, and previous surgical procedures. Orientation of the globe is followed by external examination, documenting characteristics including size, shape, and any visible lesion or abnormality. Specific attention must be paid to the presence of tumors, infectious or degenerative changes, as well as signs of trauma or prior surgery. Measurements of the globe and associated structures, including the cornea and optic nerve, and -- in fetal eyes -- anatomical and timely development are recorded. Transillumination is essential to detect a shadow, which may be caused by a mass or hemorrhage as well as increased light transmission in areas of atrophy, such as coloboma. Fixation of the globe is routinely performed in 4% paraformaldehyde to preserve the tissue. After fixation for 24 h, the globe is sectioned systematically to examine intraocular structures, such as the anterior chamber, lens status, uvea, retina, vitreous, and optic nerve. The adult globe is usually trisected along the horizontal or -- depending on the clinical indications - vertical/oblique plane to create a pupil-optic nerve (PO) section. Additional sections of the calottes may be taken to evaluate areas of interest, such as suspicious masses or areas of atrophy. For research purposes, various fixation and sectioning protocols may be considered. Each gross section is carefully inspected, documented, and processed for microscopic examination to ensure that any pathologic finding is adequately sampled. Accurate grossing and sectioning are critical for correlating clinical and histologic findings, facilitating diagnosis, guiding treatment decisions, and ultimately improving patient outcomes. Standardization of grossing and sectioning ensures a comprehensive evaluation of the eye globe and contributes to the advancement of ophthalmology.