Optic Disc Hemorrhage.jpg

OPHTHALMOBYTES

Ophthalmology at your fingertips!

A Virtual Ophthalmology Atlas!

 
 

𝗢𝗽𝘁𝗶𝗰 𝗗𝗶𝘀𝗰 𝗣𝗶𝘁 𝗠𝗮𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆⁣

Macular changes that occur secondary to optic disc pit include intraretinal and subretinal fluid accumulation⁣

Occurs in 25-75%⁣

Usually occurs at 30-40 years of age⁣

More common when the pit is located temporally ⁣




𝘍𝘰𝘶𝘳 𝘱𝘰𝘴𝘴𝘪𝘣𝘭𝘦 𝘴𝘰𝘶𝘳𝘤𝘦𝘴 𝘧𝘰𝘳 𝘵𝘩𝘦 𝘧𝘭𝘶𝘪𝘥:⁣

1. Vitreous⁣

2. Cerebrospinal fluid through the defect⁣

3. Leakage from blood vessels at the pit⁣

4. Choroid through the Bruch’s membrane and peripapillary atrophy⁣

𝘗𝘢𝘵𝘩𝘰𝘱𝘩𝘺𝘴𝘪𝘰𝘭𝘰𝘨𝘺 𝘪𝘴 𝘤𝘰𝘯𝘵𝘳𝘰𝘷𝘦𝘳𝘴𝘪𝘢𝘭:⁣

1. Vitreous traction⁣

2. Pressure gradients within the eye cause migration of fluid from the vitreous into the⁣

subretinal space⁣

𝘚𝘦𝘲𝘶𝘦𝘯𝘤𝘦 𝘰𝘧 𝘳𝘦𝘵𝘪𝘯𝘢𝘭 𝘧𝘭𝘶𝘪𝘥 𝘢𝘤𝘤𝘶𝘮𝘶𝘭𝘢𝘵𝘪𝘰𝘯 𝘢𝘯𝘥 𝘱𝘳𝘰𝘨𝘳𝘦𝘴𝘴𝘪𝘰𝘯:⁣

1. Fluid from the pit creates a schisis-like inner retinal separation, associated with a mild centrocecal scotoma⁣

2. Then, an outer layer macular hole develops beneath the inner layer, associated with a dense central scotoma⁣

3. The fluid then dissects subretinally creating an outer retinal detachment.⁣

4. OCT also supports the concept that the fluid first enters the inner retinal layers and only⁣ later makes its way to the subretinal space⁣

5. It has been suggested that as fluid accumulates intraretinally and a pressure gradient is⁣ formed that is directing it into the retina and to the subretinal space⁣

𝘛𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵:⁣

1. Observe upto 3 months for spontaneous resolution which can occur in 25% of the cases⁣

2. Laser photocoagulation to temporal margin of the disc- laser scars will create a⁣

chorioretinal adhesion which will act as a barrier between the ODP and the subretinal⁣

space⁣

3. Pars plana vitrectomy with induction of PVD and gas tamponade, ILM peeling is done by some surgeons⁣

4. Macular buckling⁣

www.ophthalmobytes.com⁣

Image from Rajan Eye Care Hospital⁣

1. Optic disc pit

2. Fluid at the macula


#ophthalmology #ophthal #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #med #medicaleducation #ophthalmologyresident #oftalmologia #surgery #surgeon #opticdisc #optician #retina


Reference: https://doi.org/10.1186/s40942-015-0013-8

54 views0 comments

Optic Disc Pit⁣






● Congenital defects arising from failure of fetal fissure closure in embryogenesis⁣

● Mostly unilateral. 10-15% bilateral⁣

Pathophysiology:⁣

● Occur due to incomplete closure of the optic fissure resulting in a micro-communication between the subarachnoid space and the pit.⁣

● Communication of optic pits and Cerebral Spinal Fluid (CSF) is controversial. Beta-2 Transferrin levels (found in CSF) of submacular fluid associated with optic pits has been variable.⁣

● Histologically, there is herniation of a dysplastic retina into the subarachnoid space through a defect in the lamina cribrosa at the pit.⁣

Symptoms:⁣

● Usually asymptomatic.⁣

● Patients may complain of metamorphopsia, micropsia, blurred or decreased vision, or a⁣

blind spot if the optic pit is associated with a serous detachment. ⁣

Signs:⁣

● Usually found inferotemporally within the nerve, 1⁄3 are central⁣

● Round or oval depression that differs in colour from the surrounding disc⁣

(grey, yellow or black)⁣

● Colour variation depends on the amount and location of glial tissue in the pit⁣

● Size can vary from 0.1-0.7 disc diameters and depth from 0.3-0.5 diopters⁣

● Associated macular edema, serous macular detachment; schisis or pigmentary changes in⁣

the macula⁣

● Shallow serous macular detachments can be seen in upto 3⁄4 eyes with inferotemporal pits⁣

Investigations:⁣

● OCT: to determine if trace amounts of subretinal fluid is seen, can show schisis-like separation between inner and outer retina.⁣

● Visual fields – Enlarged blind spot, ​arcuate scotomas .⁣

● Amsler grid can be used to monitor the onset of macular involvement of an optic pit with serous detachment.⁣

Management:⁣

● No medical therapy indicated unless it is associated with optic disc maculopathy⁣

More on optic disc maculopathy in the next ⁣

post!⁣

Image from Rajan Eye Care Hospital #ophthalmology #ophthal #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency #oftalmologia #surgery #surgeon #opticdisc

24 views0 comments
 
 

CONTACT

Sashwanthi & Madhuvanthi Mohan

 

©2019 by Ophthalmobytes. Proudly created with Wix.com