Managing elevated intraocular pressure in a patient with optic nerve hypoplasia

Case report

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Authors: Karina Marcovitch, Joseph Sowka

Published Date October 2009 Volume 2009:1(Default) Pages 1 - 5

DOI: http://dx.doi.org/10.2147/OPTO.S6823

Karina Marcovitch, Joseph Sowka

Nova Southeastern University, College of Optometry, Davie, FL, USA

Background: Optic nerve hypoplasia (ONH) is a congenital optic disc anomaly, often manifesting with visual deficits.

Case: A 51-year-old woman with a history of bilateral amblyopia was referred for glaucoma evaluation due to elevated intraocular pressure. The patient demonstrated the classic nerve head appearance of bilateral ONH with “double ring sign” and indistinguishable cupping. Despite demonstrating functional and structural measurements consistent with glaucomatous optic neuropathy, it was felt that these deficits were more likely longstanding and secondary to ONH. Additionally, in the absence of any amblyogenic factors, it was also concluded that the patient’s bilateral “amblyopia” was the result of ONH. In that the patient presented with a significant and modifiable risk factor for glaucomatous development and pre-existing retinal nerve fiber layer and visual field defects, the patient was treated with topical glaucoma medications.

Conclusion: Diagnosing glaucoma in patients with concurrent anomalies is a clinical conundrum. This report provides a review of ONH with emphasis on the common misdiagnosis of amblyopia in these patients as well as presenting a strategy for diagnosing and managing glaucoma in patients with preexisting, confounding conditions.

Keywords: optic nerve hypoplasia, glaucoma, visual field loss, scanning laser polarimetry, threshold automated perimetry

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