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Home / Ophthalmic Pathology / Uveal Tract

Uveal Tract

Mamalis Uvea 01 unlabeled  Mamalis Uvea labeled 01

Normal globe

Mamalis Uvea 02 unlabeled  Mamalis Uvea 02 labeled

Normal iris and ciliary body

Uveal tract consists of the iris, ciliary body, and choroid. It is embryologically derived from neuroectodermand neural crest

Firm attachments exist at 3 sites:

  1. Scleral spur
  2. Exit points at vortex veins
  3. Optic nerve


Mamalis Uvea 03 unlabeled  Mamalis Uvea 03 labeled

Low magnification view of normal iris

Mamalis Uvea 04 unlabeled  Mamalis Uvea 04 labeled

Higher magnification view of normal iris

The iris separates the anterior segment into anterior +posterior chambers

Ciliary Body

Mamalis Uvea 05 unlabeled  Mamalis Uvea 05 labeled

Photograph of ciliary body and zonules

Mamalis Uvea 06 unlabeled  Mamalis Uvea 06 labeled

Pars plicata

Mamalis Uvea 07 unlabeled  Mamalis Uvea 07 labeled

Pars plana

Mamalis Uvea 08 unlabeled  Mamalis Uvea 08 labeled

Transition from pars plana to retina and choroid at the ora serrata

Ciliary Body: 6-6.5mm wide–becomes continuous with choroid atora serrata

The ciliary body can be divided into 2 main areas:

  1. Pars plicata which contains the ciliary processesand zonular attachments–fimbriated
  2. Pars plana –smooth
    • a. Outer pigmented layer
    • b. Inner non-pigmented layer


Mamalis Uvea 09 unlabeled  Mamalis Uvea 09 labeled

Normal choroid

Mamalis Uvea 10 unlabeled  Mamalis Uvea 10 labeled

Normal Choroid at the ora serrata

Congenital Anomalies


Nick’s Tips: Aniridia is associated with Wilms tumor. Look for this tumor of the renal system in patients with sporadic (non-familial) aniridia. The PAX6 gene and Wilms tumor gene (WT1) are closely associated on the short arm of chromosome 11.


Mamalis Uvea 11 unlabeled  Mamalis Uvea 11 labeled

External photo of iris coloboma

Mamalis Uvea 12 unlabeled  Mamalis Uvea 12 labeled

Low magnification of iris coloboma histology

Coloboma: may affect iris, ciliary body, choroid or all 3

Fuchs’ Adenoma

Mamalis Uvea 13 unlabeled  Mamalis Uvea 13 labeled

Fuchs’ Adenoma


Mamalis Uvea 14 unlabeled  Mamalis Uvea 14 labeled

Ciliary body medulloepithelioma

Mamalis Uvea 15 unlabeled  Mamalis Uvea 15 labeled

Ciliary body medulloepithelioma

Mamalis Uvea 16 unlabeled  Mamalis Uvea 16 labeled

Cords in medulloepithelioma

Mamalis Uvea 17 unlabeled  Mamalis Uvea 17 labeled

Alcian blue stain of medulloepithelioma

Mamalis Uvea 18 unlabeled  Mamalis Uvea 18 labeled


Mamalis Uvea 19 unlabeled  Mamalis Uvea 19 labeled

High magnification view of medulloepithelioma rosette

Mamalis Uvea 20 unlabeled  Mamalis Uvea 20 labeled

Masson’s trichrome stain of a teratoid medulloepithelioma

Inflammation of the Choroid

May be infectious or non-infectious –for moreinformation, please review section on uveitis.



Sympathetic Ophthalmia

Mamalis Uvea 21 unlabeled  Mamalis Uvea 21 labeled

Diffuse choroidal inflammation in sympathetic ophthalmia

Mamalis Uvea 22 unlabeled  Mamalis Uvea 22 labeled

Histology showing choroidal inflammation

Mamalis Uvea 23 unlabeled  Mamalis Uvea 23 labeled

Granuloma formation in sympathetic ophthalmia

Mamalis Uvea 24 unlabeled  Mamalis Uvea 24 labeled

Histology of Koeppe nodule

Mamalis Uvea 25 unlabeled Mamalis Uvea 25 labeled

Masson’s trichrome stain of Koeppe nodule

Mamalis Uvea 26 unlabeled  Mamalis Uvea 26 labeled

High magnification view of a Masson’s trichrome stained Koeppe nodule

Mamalis Uvea 27 unlabeled  Mamalis Uvea 27 labeled

Histology of Dalen-Fuchs nodule

Mamalis Uvea 28 unlabeled  Mamalis Uvea 28 labeled

Anatomic location of Dalen-Fuchs nodule

Nick’s Tips: look for granulomatous inflammation with history of old injury or surgery to same or contralateral eye. Look for epithelioid histiocytes and giant cells scattered in plasma cells and lymphocytes.

Vogt –Koyanagi –Harada Syndrome


Mamalis Uvea 29 unlabeled  Mamalis Uvea 29 labeled

Noncaseating granuloma in sarcoidosis

Mamalis Uvea 30 unlabeled  Mamalis Uvea 30 labeled

Asteroid body in a multinucleated giant cell

Nick’s Tips: Clinically, granulomatous inflammation is associated with “mutton fat” keratic precipitates. Histologically, we see aggregated epithelioid histiocytes and/or inflammatory giant cells. Granulomatous inflammation is caused by certain diseases, so must search for sarcoidosis, acid-fast organisms like TB, and spirochetes. Sarcoidosis is a common cause of granulomatous inflammation –look for discrete, well circumscribed, histiocytes with giant cells separated from lymphocytes with sharp demarcations.

Rubeosis iridis

Mamalis Uvea 31 unlabeled  Mamalis Uvea 31 labeled

Rubeosis iridis

Mamalis Uvea 32 unlabeled  Mamalis Uvea 32 labeled

Histology of iris neovascularization

Mamalis Uvea 33 unlabeled  Mamalis Uvea 33 labeled

Neovascularization at the angle

Rubeosis iridis (NVI) can cause neovascular glaucoma

Rubeosis is associated with

Hyalinization of Ciliary Body

Choroidal Neovascularization (CNV)

Mamalis Uvea 34 unlabeled  Mamalis Uvea 34 labeled

Sub-RPE and subretinal neovascularization

Mamalis Uvea 35 unlabeled  Mamalis Uvea 35 labeled

Histopathology of sub-RPE neovascularization
Photo reference: Harper RA. Basic Ophthalmology. Amer Academy of Ophthalmology; 2010.

CNV may be caused by any condition that disrupts the Bruch’s Membrane such as:

  1. Age-related macular degeneration
  2. Angioid Streaks
  3. Ocular Histoplasmosis
  4. Surgery / Laser
  5. Trauma

Complications include: disciform scarring, serous or hemorrhagic detachment

Polypoidal Choroidal Vasculopathy

Iris Nevus

Mamalis Uvea 36 unlabeled  Mamalis Uvea 36 labeled

External photo of iris nevus

Mamalis Uvea 37 unlabeled  Mamalis Uvea 37 labeled

Histology of iris nevus

Mamalis Uvea 38 unlabeled  Mamalis Uvea 38 labeled

Histology of iris nevus

Mamalis Uvea 39 unlabeled  Mamalis Uvea 39 labeled

High magnification of iris nevus

Iris Nevus: increased incidence w/ neurofibromatosis type 1
Histologically leads to accumulations of dendritic or spindle cells
No cellular atypia ormitotic activity
No treatment – observation only

Iris Melanoma

Mamalis Uvea 40 unlabeled  Mamalis Uvea 40 labeled

External photo of iris melanoma

Mamalis Uvea 41 unlabeled  Mamalis Uvea 41 labeled

Histology of iris melanoma

Mamalis Uvea 42 unlabeled  Mamalis Uvea 42 labeled

Histology of iris melanoma

Mamalis Uvea 43 unlabeled  Mamalis Uvea 43 labeled

High magnification of iris melanoma

Choroid + Ciliary Body Neoplasms

Choroidal Nevus

Mamalis Uvea 44 unlabeled  Mamalis Uvea 44 labeled

Color photo of choroidal nevus

Nevus (usually located in the choroid, nevi are rare in ciliary body)

Nick’s Tips: very common –about 5% of patients. Risk of melanoma low (about 1 in 10,000 to 1 in 15,000) if no risk factors, but rises to about 38% with one risk factor and about 50% with 2 risk factors.

Risk factors for melanoma include the following:

  1. Orange pigment (lipofuscin)
  2. Serous retinal detachment
  3. Symptomatic
  4. Greater than 2mm thickness as measured with ultrasound
  5. Posterior margin of the nevus contacts the optic disc

Melanocytoma of the choroid

Mamalis Uvea 45 unlabeled  Mamalis Uvea 45 labeled

Low magnification of choroidal melanocytoma


Nick’s Tips: Very dark and heavily pigmented lesions often associated with the optic disc. You may need to bleach specimen in order to see details. When looking at bleached specimens –will see bland nuclei and a low nuclear to cytoplasmic ratio.

Choroidal Melanoma

Mamalis Uvea 46 unlabeled  Mamalis Uvea 46 labeled

Photo of choroidal melanoma

Mamalis Uvea 47 unlabeled  Mamalis Uvea 47 labeled

Histology of choroidal melanoma

Mamalis Uvea 48 unlabeled  Mamalis Uvea 48 labeled

Histology of choroidal melanoma

Mamalis Uvea 49 unlabeled  Mamalis Uvea 49 labeled

Histology of choroidal melanoma

Mamalis Uvea 50 unlabeled  Mamalis Uvea 50 labeled

Low magnification view of choroidal melanoma

Melanoma: most common primary ocular malignancy in adults

Metastatic Choroidal Tumors

Mamalis Uvea 51 unlabeled  Mamalis Uvea 51 labeled

Color photo of metastatic choroidal tumor

Mamalis Uvea 52 unlabeled  Mamalis Uvea 52 labeled

Low magnification view of metastatic choroidal tumor

Metastatic Tumors: most common intraocular tumors in adults

Nick’s Tips: usually appears yellow, white or pink mass on fundus exam. Bruch’s membrane almost always intact (mushroom shape is almost always choroidal melanoma). Most breast and lung cancers are mucous secreting so stains for mucin such as alcian blue, mucicarmine, or PAS can identify tumors. Consider immunohistochemistry to identify unknown tumors.

Other Uveal Tumors


Mamalis Uvea 53 unlabeled  Mamalis Uvea 53 labeled

Histology of hemangioma

Choroidal Osteoma:

Nick’s Tips –Look for compact bone located within the choroid on histopathology –in phthisis, the bone is located on the inner surface of the choroid associated with the RPE.


Mamalis Uvea 54 unlabeled  Mamalis Uvea 54 labeled

Histology of neurofibroma


Mamalis Uvea 55 unlabeled  Mamalis Uvea 55 labeled

Schwannoma, Antoni A form, which is a noted by the spindle-shaped cells which line up in a palisading pattern.

Mamalis Uvea 56 unlabeled  Mamalis Uvea 56 labeled

Schwannoma, Antoni B form, which has less organized, myxoid appearance


Nick’s tips: paucicellular tumor from the ciliary body area –consider schwannoma or melanoma in differential, but smooth muscle markers can make the diagnosis

Lymphoid Proliferation/Primary Choroidal Lymphoma:

Trauma of the Choroid:

Nick’s Tips: Remember trauma may be non-accidental (child abuse). The pathologist may play a role in proving trauma was abuse and careful examination of tissue may be an important factor in court cases to establish cause of death or injury.