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Stephen D Anesi, Srishti Kothari, C Stephen Foster; Interpretation and clinical correlation of histopathology and immunohistochemistry findings in conjunctival and scleral biopsy specimens: non-infectious and infectious. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1867.
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Many forms of ocular inflammatory disease have similar, and sometimes indistinguishable, presentations. We aim to report normal baseline characteristics of human conjunctiva and sclera examined via histology and immunohistochemistry, and compare them to findings expected in various disease processes, non-infectious and infectious. Information obtained via biopsy can help to distinguish between differing etiologies of ocular inflammatory disease when clinical exam, testing, and other laboratory data are unable to confirm a diagnosis. This information can be critical in the initial determination of therapy, and while changing therapy when doubts arise about a working diagnosis based on a failed response to a current regimen.
Reports of conjunctival and scleral biopsies obtained from patients with various suspected ocular surface diseases were reviewed and summarized. Information based on years of author experience with biopsies was also included. Biopsies were processed in a similar fashion, unless otherwise specified by clinical suspicion. Hematoxylin and eosin, periodic acid-Schiff, and Giemsa stains were performed on each specimen. Direct immunofluorescence included antibodies against IgA, IgG, IgM, C3, C4, IgE, IgD, fibrinogen, albumin, and collagen IV, and was performed on each specimen as well. When clinical suspicion warranted, specimens were also analyzed via direct immunofluorescence of antibodies against herpes simplex (HSV) and varicella zoster virus (VZV) antigens, in serial dilutions. All studies were compared with appropriate controls at the time of reading.
Findings of both normal conjunctiva and sclera, examined using histology and immunohistochemistry, are reported here. Findings in various pathologic conditions, including chronic conjunctivitis, scleritis, and infectious/viral ocular surface disease are also reported.
We demonstrate expected histologic and immunohistochemical findings in normal conjunctival and scleral biopsies, and also report how these findings differ in various infectious and noninfectious conditions affecting the ocular surface and scleral wall. We hope that this will further aid in the diagnosis and eventual management of these conditions, or help augment clinical suspicion in cases where data is otherwise inconclusive.
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