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    Imaging helps in optic disc pit diagnosis

    Rule out detachment and quantify nerve fiber defects

    Optic disc pits are infrequently encountered clinical findings that are diagnosed through biomicroscopy during routine examination. Visual acuity will be normal unless the macular structure is compromised. Advanced diagnostic imaging with devices such as spectral-domain optical coherence tomography (SD-OCT) have become critical in the detection of disorders of the macula and optic nerve. I present a case of an optic nerve pit with associated nerve fiber defect that is highlighted by a corresponding thinning of the macular ganglion cell complex (mGCC) and paracentral scotoma on visual field testing.

    Case presentation

    Figure 1. Fundus Photo OD Figure 1. Fundus Photo OD A 33-year-old East Indian male presented for a routine examination with a chief complaint of more noticeable floaters over the past year. His ocular health history was significant for an optic nerve pit in the right eye, which had been diagnosed at his initial encounter at our office three years prior. At that initial visit, the patient recalled being told of “some pigmentation around the eye” at a previous exam, but was unsure of the nature of the condition. His family history was positive for glaucoma on his father’s side. He was currently taking no medication and reported normal systemic health.

    Examination revealed acuities correctable to OD 20/15- and OS 20/15. Extraocular motility was full, and pupils were equal, round, and reactive to light with no evidence of afferent defect. Confrontation fields were full to finger counting in both eyes. The anterior segment revealed normal findings with mild perilimbal melanosis of the bulbar conjunctiva OU. Intraocular pressure by non-contact tonometry measured 12/14 mm Hg.

    Dilated fundus examination revealed mild vitreal syneresis with no evidence of holes or tears in the peripheral retina OU. The optic nerves demonstrated an oblong shape with asymmetric size and cupping OD>OS (Figures 1 and 2). Peripapillary pigment was more pronounced at the temporal aspect of the right nerve. There was also an oval reddish-brown pit at the inferotemporal aspect of the right optic nerve with an adjacent deep nerve fiber layer wedge defect. 




    Nicholas A. Froumis, OD
    Dr. Nicholas A. Froumis is a 2005 graduate of University of California, Berkeley School of Optometry. He works in private practice in ...


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    Optometry Times A/V