34. Hole in optic nerve
A 44-year-old with long standing vision problems is new to your area. You perform an OCT, shown below. What is the cause of the problems?
In this scan there is clear evidence of both intraretinal and subretinal fluid. In addition, there is a hypo reflective signal coming from the temporal disc, consistent with an optic pit.
In any patient with subretinal fluid, always look closely at the disc to rule out the possibility of an optic pit.
Suggested follow-up / referral
The presence of subretinal fluid warrants urgent referral, as the differential diagnosis includes retinal vascular disease, macular degeneration and neoplastic disease. In the case of fluid related to an optic pit, vitrectomy may be of benefit.