ACP Best Practice No 164: Necropsy techniques in ophthalmic pathology

Abstract

Much important information can be obtained at necropsy by the pathological examination of the eye and its adnexal structures in adults and children. This information may be related to the cause of death (for example, violent shaking trauma in physical child abuse), or may pertain to disease processes aVecting the eye, the orbit, and surrounding structures outside the orbit. This article reviews the technical methods used to remove the following: the vitreous (for example, for biochemistry); the eye itself (anterior approach); the eye and orbital contents (posterior approach); the eye, orbit and orbital walls; and the eye, orbital walls, and surrounding structures. The removal of the eye and adnexal ocular structures must be recognised as a "culturally sensitive" issue, which must be approached cautiously. It should only be undertaken for sound scientific reasons, with the fully informed consent of the relatives and/or the coroner (or equivalent authority), and with properly agreed procedures for the eventual retention or disposal of the ocular tissues. For this reason, this article reviews not only the scientific indications and methods for the removal of such tissues, but also the legal and ethical issues that must underpin this pathology "best practice". (J Clin Pathol 2001;54:417-427)

The Eye in Forensic Medicine: A Narrative Review

“…In some suspicious trauma or pediatric cases, post-mortem assessment of the fundus has relied on ocular enucleation to aid with the diagnosis of the cause of death 16 . Recently, post-mortem ophthalmic endoscopy and monocular indirect ophthalmoscopy have been described, and although not currently routinely used, may prove useful in the initial examination of the eye in forensic autopsy cases 110–113 as eye enucleation can result in artifacts 114 .…”

“…In some suspicious trauma or pediatric cases, post-mortem assessment of the fundus has relied on ocular enucleation to aid with the diagnosis of the cause of death. 16 Recently, postmortem ophthalmic endoscopy and monocular indirect ophthalmoscopy have been described, and although not currently routinely used, may prove useful in the initial examination of the eye in forensic autopsy cases 110 -113 as eye enucleation can result in artifacts. 114 The instant endoscopic inspection and documentation of the fundus in forensic autopsies may be further beneficial for practical reasons, to justify post-mortem enucleation of the eyeball which is restricted in some countries in the presence of pathological findings.…”

“…Additionally, post-mortem ocular examination may aid in determining the cause of death and provide clues regarding the length and severity of multisystem disease processes in certain cases 14,15 . Post-mortem findings may also assist in the identification of visual impairment conditions which could have contributed to an individual's demise, for example, road traffic accidents or other accidental deaths 16 …”

“…14,15 Post-mortem findings may also assist in the identification of visual impairment conditions which could have contributed to an individual's demise, for example, road traffic accidents or other accidental deaths. 16 Post-mortem changes vary for each of the different components of the eye, and some elements may prove useful in forensic pathology. Particular focus will be given to post-mortem iris recognition, post-mortem measurement of vitreous compound levels, the retina in pediatric abusive head trauma, and the use of ophthalmic imaging such as optical coherence tomography (OCT) to aid diagnosis of the condition, as we recognize these areas have shown potential for routine implementation in practice and/or necessitate further exploration before routine use.…”

Whole blood Taqman PCR leads in confirming meningococcal disease

“…The journal, together with the other journals in the BMJ Publishing Group, has undergone a major change in layout, which makes it easier to read. We have also introduced several new sections, such as Historical Fillers, [9][10][11] Grand Round Presentations, 12 Best Practice Papers, [13][14][15][16][17][18][19][20][21][22][23][24] and ECHOES. The latest addition to this arsenal is the Diagnostic Brief.…”