This healthy 20YO female presented with asymptomatic unilateral optic nerve findings in her right eye. Vision was 20/20 OD and 20/20 in her normal OS.
Color photography shows two independent optic nerve pits along the temporal edge of the nerve. OCT angiography dramatically illustrates the pits due to completely absent flow signals. The pits are also well imaged on OCT scans. Observation was recommended.
Learning Points:
An optic nerve pit is a rare (about 0.1% prevalence) congenital anomaly thought to be caused by incomplete closure of the optic fissure during gestation. Pits are most often located within or along the inferior-temporal disc margin and usually appear as a gray depression. Double pits are exceedingly rare (Babu et al, Indian J Ophthalmol 2020;68:663-665).
While most optic pits are asymptomatic, they can cause vision loss by forcing fluid into the inner retina, outer retina, and, ultimately, the subretinal space (optic pit maculopathy). The source of the fluid remains a subject of ongoing debate, with opinions ranging from the vitreous to the subarachnoid space.
