Pitted Disc!


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!⁣

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