Skip to main content

Advertisement

SpringerLink
Log in

Optic disc pit: a review

  • Review Article
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Since Wiethe first described the clinical presentation of two optic disc depressions in a 62-year-old woman in 1882, there have been many studies addressing what later become known as the “optic disc pit.” The main complication of this condition, termed optic disc pit maculopathy, is associated with visual deterioration. Treatment of optic disc pit maculopathy remains challenging.

Methods

Here we review the body of literature that documents the clinical findings, pathophysiology, histology, main complications, treatment options, special features and presentations, and differential diagnosis of optic disc pit.

Results

The source of the intraretinal fluid in optic disc pit maculopathy remains controversial. Four possible sources of this fluid have been proposed: fluid from the vitreous cavity; cerebrospinal fluid originating from the subarachnoid space; fluid from leaky blood vessels at the base of the pit; and fluid from the orbital space surrounding the dura.

Conclusions

Optic disc pits are a very rare clinical entity, affecting approximately one in 11,000 people. Patients with congenital optic disc pit sometimes remain asymptomatic, but 25% to 75% present with visual deterioration in their 30s or 40s after developing macular schisis and detachment. The most widely accepted treatment for such patients is a surgical approach involving pars plana vitrectomy with or without internal limiting membrane peeling, with or without endolaser photocoagulation and C3F8 endotamponade.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Wiethe T (1882) Ein Fall von angeborener Deformität der Sehnervenpapille. Arch Augenheilkd 11:14–19

    Google Scholar 

  2. Reis W (1908) Eine wenig bekannte typische Missbildung am Sehnerveneintritt: umschriebene Grubenbildung auf der Papilla r optici. Arch Augenheilkd 19:505–528

    Google Scholar 

  3. James R (1913) Crater-like hole in the disc associated with changes at the macula. Ophthalmol Rev 32:38–40

    Google Scholar 

  4. Halbertsma K (1927) Crater-like hole and coloboma of the disc associated with changes at the macula. Br J Ophthalmol 11:11–17

    Article  PubMed  CAS  Google Scholar 

  5. Rosen E (1948) Crater-like holes in the optic disc. Br J Ophthalmol 32:465–478

    Article  Google Scholar 

  6. Kranenburg E (1960) (1960) Crater-like holes in the optic disc and central serous retinopathy. Arch Ophthalmol 64:912–924

    PubMed  CAS  Google Scholar 

  7. Chang M (1976) Pits and crater-like holes of the optic disc. Ophthalmol Sem 1:21–61

    CAS  Google Scholar 

  8. Ugurlu S, Weitzman M, Nduaguba C, Caprioli J (1998) Acquired pit of the optic nerve: a risk factor for progression of glaucoma. Am J Ophthalmol 125(4):457–464

    Article  PubMed  CAS  Google Scholar 

  9. Brodsky MC (1994) Congenital optic disc anomalies. Surv Ophthalmol 39:89–112

    Article  PubMed  CAS  Google Scholar 

  10. Brown G, Tasman W (1983) Congenital anomalies of the optic disc. Grune & Stratton, New York, pp 31–215

    Google Scholar 

  11. Brown GS, Shieds JA, Goldberg RE (1980) Congenital pits of the optic nerve head II. Clinical studies in humans. Ophthalmology 87:51–65

    PubMed  CAS  Google Scholar 

  12. Stefko ST, Campochiaro P, Wang P, Li Y, Zhu D, Traboulsi EI (1997) Dominant inheritance of optic pits. Am J Ophthalmol 124(1):112–113

    PubMed  CAS  Google Scholar 

  13. Krivoy D, Gentile R, Liebmann JM, Stegman Z, Rosen R, Walsh JB, Ritch R (1996) Imaging congenital optic disc pits and associated maculopathy using optical coherence tomography. Arch Ophthalmol 114(2):165–170

    PubMed  CAS  Google Scholar 

  14. Reed D (1999) Congenital pits of the optic nerve. Clin Eye Vis Care 11(2):75–80

    Article  Google Scholar 

  15. Gass JDM (1969) Serous detachment of the macula secondary to congenital pit of the opticnervehead. Am J Ophthalmol 67:821–841

    PubMed  CAS  Google Scholar 

  16. Chan JW (2007) Optic nerve disorders: diagnosis and management. Chapter 8. Springer, New York, pp 208–209

    Google Scholar 

  17. Irvine AR, Crawford JB, Sullivan JH (1986) The pathogenesis of retinal detachment with morning glory disc and optic pit. Retina 6(3):146–150

    Article  PubMed  CAS  Google Scholar 

  18. Lin CC, Tso MO, Vygantas CM (1984) Coloboma of optic nerve associated with serous maculopathy. A clinicopathologic correlative study. Arch Ophthalmol 102(11):1651–1654

    PubMed  CAS  Google Scholar 

  19. Meyer CH, Rodrigues EB, Schmidt JC (2003) Congenital optic nerve head pit associated with reduced retinal nerve fibre thickness at the papillomacular bundle. Br J Ophthalmol 87(10):1300–1301

    Article  PubMed  CAS  Google Scholar 

  20. Ferry AP (1963) Macular detachment associated with congenital pit of the optic nerve head. Arch Ophthalmol 70:106–117

    Google Scholar 

  21. Akiba J, Kakehashi A, Hikichi T, Trempe CL (1993) Vitreous findings in cases of optic nerve pits and serous macular detachment. Am J Ophthalmol 116(1):38–41

    PubMed  CAS  Google Scholar 

  22. Halbertsma KTA (1927) Craterlike hole and coloboma of disc associated with changes at macula. Br J Ophthalmol 11:11

    Article  PubMed  CAS  Google Scholar 

  23. Sugar HS (1964) Congenital pits of the optic disc. Am J Ophthalmol 57:833–835

    PubMed  CAS  Google Scholar 

  24. Sugar HS (1967) Congenital pits of the optic disc. Am J Ophthalmol 63:298–307

    PubMed  CAS  Google Scholar 

  25. Petersen HP (1958) Pits or crater-like holes in the optic disc. Acta Ophthalmol (Copenh) 36:453–43

    Google Scholar 

  26. Bonnet M (1991) Serous macular detachment associated with optic nerve pits. Arch Clin Exp Ophthalmol 229:526–532

    Article  CAS  Google Scholar 

  27. Snead MP, James N, Jacobs PM (1991) Vitrectomy, argon laser, and gas tamponade for serous retinal detachment associated with an optic disc pit: a case report. Br J Ophthalmol 75(6):381–382

    Article  PubMed  CAS  Google Scholar 

  28. Schatz H, McDonald HR (1988) Treatment of sensory retinal detachment associated with optic nerve pit or coloboma. Ophthalmology 95(2):178–186

    PubMed  CAS  Google Scholar 

  29. Georgalas I, Kouri A, Ladas I, Gotzaridis E (2010) Optic disc pit maculopathy treated with vitrectomy, internal limiting membrane peeling, and air in a 5-year-old boy. Can J Ophthalmol 45(2):189–191

    Article  PubMed  Google Scholar 

  30. Yuen CH, Kaye SB (2002) Spontaneous resolution of serous maculopathy associated with optic disc pit in a child: a case report. J AAPOS 6(5):330–331

    Article  PubMed  Google Scholar 

  31. Brown GC, Shields JA, Patty BE, Goldberg RE (1979) Congenital pits of the optic nerve head. I. Experimental studies in collie dogs. Arch Ophthalmol 97(7):1341–1344

    PubMed  CAS  Google Scholar 

  32. Kuhn F, Kover F, Szabo I, Mester V (2006) Intracranial migration of silicone oil from an eye with optic pit. Graefes Arch Clin Exp Ophthalmol 244(10):1360–1362

    Article  PubMed  Google Scholar 

  33. Regenbogen L, Stein R, Lazar M (1964) Macular and juxtapapillary serous retinal detachment associated with pit of the optic disc. Ophthalmologica 148:247–251

    Article  PubMed  CAS  Google Scholar 

  34. Gordon R, Chatfield RK (1969) Pits in the disc associated with macular degeneration. Br J Ophthalmol 53:481–489

    Article  PubMed  CAS  Google Scholar 

  35. Wise G, Dollery C, Henkind P (1971) Disciform macular disease. In: Wise G, Dollery C, Henkind P (eds) The retinal circulation. Harper & Row, New York, p 471

    Google Scholar 

  36. Apple DJ, Rabb MF, Walsh PM (1988) Congenital anomalies of the optic disc. Surv Ophthalmol 27:3–41

    Article  Google Scholar 

  37. Lincoff H, Lopez R, Kreissig I, Yannuzzi L, Cox M, Burton T (1988) Retinoschisis associated with optic nerve pits. Arch Ophthalmol 106:61–67

    PubMed  CAS  Google Scholar 

  38. Brockhurst RJ (1975) Optic pits and posterior retinal detachment. Trans Am Ophthalmol Soc 73:264–291

    PubMed  CAS  Google Scholar 

  39. Postel EA, Pulido JS, McNamara JA, Johnson MW (1998) The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies. Trans Am Ophthalmol Soc 96:73–88

    PubMed  CAS  Google Scholar 

  40. Theodossiadis G (1977) Evolution of congenital pit of the optic disc with macular detachment in photocoagulated and non photocoagulated eyes. Am J Ophthalmol 84:620–631

    PubMed  CAS  Google Scholar 

  41. Theodossiadis GP (1996) Treatment of maculopathy associated with optic disc pit by sponge explant. Am J Ophthalmol 121:630–637

    PubMed  CAS  Google Scholar 

  42. Doyle E, Trivedi D, Good P, Scott RA, Kirkby GR (2009) High-resolution optical coherence tomography demonstration of membranes spanning optic disc pits and colobomas. Br J Ophthalmol 93(3):360–365

    Google Scholar 

  43. Imamura Y, Zweifel SA, Fujiwara T, Freund KB, Spaide RF (2010) High-resolution optical coherence tomography findings in optic pit maculopathy. Retina 30(7):1104–1112

    Article  PubMed  Google Scholar 

  44. Chiu YT, Chen HY, Tsai YY, Lin JM, Chiang CC (2006) Stratus optical coherence tomography for evaluating optic disc pits associated with maculopathy before and after vitrectomy: two case reports. Kaohsiung J Med Sci 22(5):229–234

    Article  PubMed  Google Scholar 

  45. Lincoff H, Schiff W, Krivoy D, Ritch R (1996) Optic coherence tomography of optic disk pit maculopathy. Am J Ophthalmol 122(2):264–266

    PubMed  CAS  Google Scholar 

  46. Brasil OF, Brasil MV, Brasil OM (2006) Different presentations of intraretinal fluid collections in optic disc pits: OCT study of 3 cases. Arq Bras Oftalmol 69(5):745–747

    Article  PubMed  Google Scholar 

  47. Theodossiadis PG, Grigoropoulos VG, Emfietzoglou J, Theodossiadis GP (2007) Vitreous findings in optic disc pit maculopathy based on optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 245(9):1311–1318

    Article  PubMed  Google Scholar 

  48. Mustonen E, Varonen T (1972) Congenital pit of the optic nerve head associated with serous detachment of the macula. Acta Ophthalmol (Kbh) 50:689–698

    Article  CAS  Google Scholar 

  49. Lincoff H, Yannuzzi L, Singerman L, Kreissig I, Fisher Y (1993) Improvement in visual function after displacement of the retinal elevations emanating from optic pits. Arch Ophthalmol 111(8):1071–1079

    PubMed  CAS  Google Scholar 

  50. Rosa AAM, Primiano Júnior HP, Nakashima Y (2006) Retinopexia pneumática e fotocooagulação a laser para tratamento de descolamento secundário à fosseta de disco óptico: relato de caso. Arq Bras Oftalmol 69(1):101–105

    Article  PubMed  Google Scholar 

  51. Cox MS, Witherspoon CD, Morris RE, Flynn HW (1988) Evolving techniques in the treatment of macular detachment caused by optic nerve pits. Ophthalmology 95(7):889–896

    PubMed  CAS  Google Scholar 

  52. Hirakata A, Okada AA, Hida T (2005) Long-term results of vitrectomy without laser treatment for macular detachment associated with an optic disc pit. Ophthalmology 112(8):1430–1435

    Article  PubMed  Google Scholar 

  53. Dai S, Polkinghorne P (2003) Peeling the internal limiting membrane in serous macular detachment associated with congenital optic disc pit. Clin Exp Ophthalmol 31(3):272–275

    Article  Google Scholar 

  54. Snead MP, James N, Jacobs PM (1991) Vitrectomy, argon laser, and gas tamponade for serous retinal detachment associated with an optic disc pit: a case report. Br J Ophthalmol 75(6):381–382

    Article  PubMed  CAS  Google Scholar 

  55. Ghosh YK, Banerjee S, Konstantinidis A, Athanasiadis I, Kirkby GR, Tyagi AK (2008) Surgical management of optic disc pit associated maculopathy. Eur J Ophthalmol 18(1):142–146

    PubMed  CAS  Google Scholar 

  56. Georgalas I, Petrou P, Koutsandrea C, Papaconstadinou D, Ladas I, Gotzaridis E (2009) Optic disc pit maculopathy treated with vitrectomy, internal limiting membrane peeling, and gas tamponade: a report of two cases. Eur J Ophthalmol 19(2):324–326

    PubMed  Google Scholar 

  57. Spaide RF, Fisher Y, Ober M, Stoller G (2006) Surgical hypothesis: inner retinal fenestration as a treatment for optic disc pit maculopathy. Retina 26(1):89–91

    Article  PubMed  Google Scholar 

  58. Snead MP, James N, Jacobs PM (1991) Vitrectomy, argon laser, and gas tamponade for serous retinal detachment associated with an optic disc pit: a case report. Br J Ophthalmol 75:381–382

    Article  PubMed  CAS  Google Scholar 

  59. Hirakata A, Hida T, Wakabayashi T, Fukuda M (2005) Unusual posterior hyaloid strand in a young child with optic disc pit maculopathy: intraoperative and histopathological findings. Jpn J Ophthalmol 49:264–266

    Article  PubMed  Google Scholar 

  60. Ishikawa K, Terasaki H, Mori M, Sugita K, Miyake Y (2005) Optical coherence tomography before and after vitrectomy with internal limiting membrane removal in a child with optic disc pit maculopathy. Jpn J Ophthalmol 49:411–413

    Article  PubMed  Google Scholar 

  61. Rosenthal G, Bartz-Schmidt KU, Walter P, Heimann K (1998) Autologous platelet treatment for optic disc pit associated with persistent macular detachment. Graefes Arch Clin Exp Ophthalmol 236(2):151–153

    Article  PubMed  CAS  Google Scholar 

  62. Meyer CH, Rodrigues EB (2004) Optic disc pit maculopathy after blunt trauma. Eur J Ophthalmol 14(1):71–73

    PubMed  CAS  Google Scholar 

  63. Colyer MH, Weichel ED, Ward TP (2007) Blast injury-associated optic disc pit maculopathy. Br J Ophthalmol 91(4):558

    Article  PubMed  Google Scholar 

  64. Hirakata A, Hida T, Wakabayashi T, Fukuda M (2005) Unusual posterior hyaloid strand in a young child with optic disc pit maculopathy: intraoperative and histopathological findings. Jpn J Ophthalmol 49(3):264–266

    Article  PubMed  Google Scholar 

  65. Rodriguez-Coleman H, Schiff WM, Hwang JC, Speaker MG (2007) Optic pit maculopathy after laser-assisted in situ keratomileusis. Can J Ophthalmol 42(1):123–124

    PubMed  Google Scholar 

  66. Pollock JA, Newton TH, Hoyt WF (1968) Transsphenoidal and transethmoidal encephaloceles. Radiology 90:442–453

    PubMed  CAS  Google Scholar 

  67. Caprioli J, Lesser R (1983) Basal encephalocele and morning glory syndrome. Br J Ophthalmol 67:349–351

    Article  PubMed  CAS  Google Scholar 

  68. Fea A, Grosso A, Rabbione M, Grignolo F (2007) Alagille syndrome and optic pit. Graefes Arch Clin Exp Ophthalmol 245(2):315–317

    Article  PubMed  Google Scholar 

  69. Kim BJ, Fulton AB (2007) The genetics and ocular findings of Alagille syndrome. Semin Ophthalmol 22(4):205–210

    Article  PubMed  Google Scholar 

  70. Asensio Sánchez VM, Corral Azor A, Bartolomé Aragón A, De Paz García M (2002) Renal-coloboma syndrome. Arch Soc Esp Oftalmol 77(11):635–638

    PubMed  Google Scholar 

  71. Corbett JJ, Savino PJ, Schatz NJ, Orr LS (1980) Cavitary developmental defects of the optic disc. Visual loss associated with optic pits and colobomas. Arch Neurol 37(4):210–213

    PubMed  CAS  Google Scholar 

  72. Fasciani R, Mosca L, Giannico ML, Legrottaglie EF, Balestrazzi E (2008) Unusual coexistence of bilateral keratoconus and optic disc pit: a case report. Eur J Ophthalmol 18(1):134–137

    PubMed  CAS  Google Scholar 

  73. Theodossiadis GP, Ladas ID, Panagiotidis DN, Kollia AC, Voudouri AN, Theodossiadis PG (1999) Fluorescein and indocyanine green angiographic findings in congenital optic disk pit associated with macular detachment. Retina 19(1):6–11

    Article  PubMed  CAS  Google Scholar 

  74. Hiraoka T, Inoue M, Ninomiya Y, Hirakata A (2010) Infrared and fundus autofluorescence imaging in eyes with optic pit maculopathy. Clin Exp Ophthalmol 38(7):669–677

    Article  Google Scholar 

  75. Smith JL (1977) The optic nerve work up. Trans Am Acad Ophthalmol Otolaryngol 83:778–785

    CAS  Google Scholar 

  76. Lichter PR, Henderson JW (1977) Optic nerve infarction. Trans Am Ophthalmol Soc 75:103–121

    PubMed  CAS  Google Scholar 

  77. Radius RL, Maumenee AE, Green WR (1978) Pit-like changes of the optic nerve head in open-angle glaucoma. Br J Ophthalmol 62(6):389–393

    Article  PubMed  CAS  Google Scholar 

  78. Spaeth GL (1980) Low-tension glaucoma: its diagnosis and management. In: Greve EL (ed) Glaucoma symposium: diagnosis and therapy, Amsterdam, 1979. Doc Ophthalmol Proc Ser 22. Dr W. Junk, The Hague, pp 263–287

    Google Scholar 

  79. Javitt JC, Spaeth GL, Katz LJ, Poryzees E, Addiego R (1990) Acquired pits of the optic nerve. Increased prevalence in patients with low-tension glaucoma. Ophthalmology 97(8):1038–1043, discussion 1043–1034

    PubMed  CAS  Google Scholar 

  80. Spaeth GL (1994) A new classification of glaucoma including focal glaucoma. Surv Ophthalmol 38:S9–S17

    Article  PubMed  Google Scholar 

  81. Cashwell LF, Ford JG (1995) Central visual field changes associated with acquired pits of the optic nerve. Ophthalmology 102(9):1270–1278

    PubMed  CAS  Google Scholar 

  82. Healey PR, Mitchell P (2008) The prevalence of optic disc pits and their relationship to glaucoma. J Glaucoma 17(1):11–14

    Article  PubMed  Google Scholar 

  83. Rath EZ, Rumelt S (2007) Acute visual loss due to serous retinal detachment from acquired optic pit may be a rare presentation of primary open-angle glaucoma. Can J Ophthalmol 42(2):339–340

    Article  PubMed  Google Scholar 

  84. Yamakiri K, Uemura A, Sakamoto T (2004) Retinal detachment caused by a slitlike break within the excavated disc in morning glory syndrome. Retina 24(4):652–653

    Article  PubMed  Google Scholar 

  85. Coll GE, Chang S, Flynn TE, Brown GC (1995) Communication between the subretinal space and the vitreous cavity in the morning glory syndrome. Graefes Arch Clin Exp Ophthalmol 233(7):441–443

    Article  PubMed  CAS  Google Scholar 

Download references

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper

Author information

Authors and Affiliations

  1. Department of Ophthalmology, “G.Gennimatas” Hospital of Athens, University of Athens, 59 Chrysanthemon str, 15452, Athens, Greece

    Ilias Georgalas, Ioannis Ladas, Gerasimos Georgopoulos & Petros Petrou

Authors
  1. Ilias Georgalas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ioannis Ladas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerasimos Georgopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petros Petrou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilias Georgalas.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM

(PDF 28.5 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Georgalas, I., Ladas, I., Georgopoulos, G. et al. Optic disc pit: a review. Graefes Arch Clin Exp Ophthalmol 249, 1113–1122 (2011). https://doi.org/10.1007/s00417-011-1698-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-011-1698-5

Keywords

Search

Navigation