Rare Pediatric Case: Optic Nerve Pit

An optometrist uploaded this case to Care1.

A 12-year-old girl was uploaded for a suspected optic pit OD. Refractive error showed low hyperopia/astigmatism OU with no amblyopia. Pupils were equal OU.

Care1 Retina Surgeon’s Clinical Insight

This appears to be an optic nerve pit in the right eye (OD). Optic nerve pits are rare conditions, found in fewer than 1 in 10,000 people. They do not typically affect visual acuity unless there is macular involvement (e.g., serous retinal detachment, retinal schisis, or CME). From a pathophysiology perspective, fluid from the vitreous or cerebrospinal fluid (CSF) may travel through the pit into the macula via a communication with the subarachnoid space. For this particular patient, as there are no current signs of macular involvement, we would recommend continued observation and follow-up with the optometrist. Care1 OMDs can remain involved remotely.

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Care1 AI’s Clinical Insight

Optic nerve pits are congenital excavations of the optic disc that are typically asymptomatic but can occasionally lead to significant visual disturbances if fluid migrates into the macula. Early detection and monitoring are key. OCT plays a crucial role in identifying any macular changes, especially in pediatric cases where diagnosis may be delayed. Management is typically conservative unless macular involvement occurs, at which point surgical intervention may be necessary.