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Symptoms ⬇

Asymptomatic if isolated. May notice distortion of straight lines or edges, blurred vision, a blind spot, or micropsia if macular fluid develops.

Signs ⬆ ⬇

(See Figure 11.34.1.)

Critical

Small, round depression (usually gray, yellow, or black in appearance) in the nerve tissue of the optic disc. Most are temporal, approximately one-third are central, but may be present anywhere on the nerve head.

Other

Peripapillary atrophy, white or gray membrane overlying pit, rarely RAPD, various visual field defects. May develop localized detachment of the sensory retina and/or retinoschisis extending from the disc to the macula, usually unilateral.

11-34.1 Optic pit with associated serous macular detachment.

Gervasio-ch011-image058

Differential Diagnosis ⬆ ⬇

Work Up ⬆ ⬇

Workup

Treatment ⬆ ⬇

  1. Isolated optic pit: No treatment required.
  2. Optic pit with macular fluid causing vision loss: Watchful waiting or vitrectomy and intravitreal gas are most commonly used. Laser photocoagulation to the temporal margin of the optic disc and macular buckling have also been described.

Follow Up ⬆

  1. Isolated optic pits: Yearly examination including IOP check, dilated fundus examination, and visual field testing if indicated; sooner if symptomatic. Patients should be given an Amsler grid. See Appendix 4, AMSLER GRID. Monitor for and treat amblyopia if present.
  2. Optic pits with serous macular detachment or retinoschisis: Refer for retinal evaluation.