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Cristina Fonseca, Norah Alsaif, Mohammed F Qutub, Silvin Bakalian, Vasco Bravo-Filho, Miguel N Burnier; A large series of blind painful eyes: potential causes and associated histopathological features. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3418.
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A blind painful eye is the end stage of several ocular conditions, including inflammatory, vascular, and glaucomatous changes. The aim of this project is to describe the morphological findings of blind painful eyes and to evaluate the most frequent histopathological features of this condition.
One hundred and seventy-two cases of enucleated or eviscerated blind painful eyes were reviewed from the Henry C. Witelson Ocular Pathology Laboratory, McGill University over a 21 year period (1993-2014). A review of the histopathological features to establish criteria for the diagnosis of blind painful eyes was performed. The underlying causes of the blind painful eyes were determined clinically and histopathologically.
Of the 172 blind painful eyes, 95 (55.2%) were eviscerated and 77 (44.7%) were enucleated. Phthisical eyes were diagnosed by the presence of disorganization with osseous metaplasia and calcification in shrunken eyes (<16 mm in diameter), and represented 18% of all cases. Mean patient age was 55.6 years (1-88) with equal sex distribution. Fifty-four histopathological features were identified, the most common being retinal gliosis (70.9%), chronic keratitis (69.1%), and non-granulomatous chronic uveitis (50%). Other findings included total retinal detachment (34.3%), subretinal hemorrhage (32.5%), anterior synechia (29.6%), optic nerve atrophy (25.5%), subepithelial pannus (25%), bone metaplasia (16.8%), and rubeosis iridis (8.1%), among others. The histopathological changes were further classified according to clinicopathologic features: over 90% of cases had findings consistent with retinal vascular diseases, retinal detachment (83%), uveitis (79%), keratitis (72%), glaucomatous changes (37%), cataract (21%), and corneal decompensation (18%).
To the best of our knowledge, this is the first study of blind painful eyes describing the histopathological features and the underlying ocular disease. The clinical criteria for the diagnosis of a blind painful eye includes retinal detachment and gliosis, disorganization of ocular structures, and glaucomatous atrophic changes. A wide spectrum of ocular conditions can lead to a blind painful eye. Pathological evaluation of blind painful eyes may help ophthalmologists formulate an accurate clinicopathological correlation of the baseline ocular disease.
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