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   Table of Contents      
Year : 2020  |  Volume : 68  |  Issue : 10  |  Page : 2225-2226

A pigmented disc in glaucoma!

1 Glaucoma Consultant, Sita Lakshmi Glaucoma Center, Anand Eye Institute, Hyderabad, Telangana, India
2 Retina Consultant, Anand Eye Institute, Hyderabad, Telangana, India

Date of Submission29-Jan-2020
Date of Acceptance18-May-2020
Date of Web Publication23-Sep-2020

Correspondence Address:
Dr. Tarannum Mansoori
Glaucoma Consultant, Sita Lakshmi Glaucoma Center, Anand Eye Institute, Habsiguda - 500 007, Hyderabad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_192_20

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Keywords: Glaucoma, pigmented optic disc, optic disc anamoly

How to cite this article:
Mansoori T, Agraharam SG. A pigmented disc in glaucoma!. Indian J Ophthalmol 2020;68:2225-6

How to cite this URL:
Mansoori T, Agraharam SG. A pigmented disc in glaucoma!. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 20];68:2225-6. Available from: https://www.ijo.in/text.asp?2020/68/10/2225/295687

An 81-year-old male was referred for glaucoma evaluation. He gave a history of cataract and trabeculectomy surgery performed for the right eye (RE) 2 years ago and was using topical brimonidine tartrate 0.15% and timolol maleate 0.5% combination in the left eye (LE).

On examination, his best corrected visual acuity was 20 / 20 in both the eyes (BE). Right eye showed diffuse, cystic bleb, BE were pseudophakic and there was no evidence of nevi or any other pigmented lesion on the conjunctiva, sclera, or iris. Intraocular pressure was 10 mmHg in RE and14 mmHg in the LE. Optic disc showed small disc, 0.7:1 cup disc ratio (CDR) diffuse, uniform pigmentation of the optic nerve head with no elevation or extension of pigment into the surrounding retina and inferior neuroretinal rim notch [Figure 1]a. The demarcation between the pigmented margin of the cup and disc margin was distinct. LE optic disc showed a small disc, 0.9:1 CDR and bipolar notch [Figure 1]b. The surrounding retina had drusen and retinal pigment epithelial atrophy in BE. Humphrey visual field 24-2, SITA standard showed superior arcuate scotoma in the RE [Figure 2], and biarcuate scotoma in the LE.
Figure 1: Fundus photograph showing a diffusely pigmented, small size, optic disc (a), and inferior notch in the right eye. The left optic disc (b) shows small-sized disc and bipolar notch

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Figure 2: Humphrey visual field 24-2 showing superior arcuate scotoma in the right eye

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Optic disc pigmentation is a rare finding and can be primary or secondary. Patients in the primary group often have associated ocular abnormalities.[1],[2]

  Discussion Top

A report has described a family of three siblings with partial trisomy l0 q and documented an unusual enlarged optic disks with a gray cast and elevated, poorly defined margins of the optic disc in one of the siblings.[2] Another report describes a case of a 48-year-old white woman who was found to have an entirely pigmented optic disc in an otherwise normal eye.[3] A study reported prevalence of the optic disc anomalies in the adult South Indian population and optic disc pigmentation was noted in 0.03% of the population.[4] Secondary optic disc pigmentation can be due to melanocytoma, hemolysis from hemorrhage within the optic nerve or extensive siderosis.[5]

On review of the literature, we could not find photographic documentation of benign pigmentation of the entire optic disc in association with primary open angle glaucoma (POAG). Although the origin of pigment within the optic disc remains speculative in our patient without histologic confirmation, it represents an unusual presentation of a benign optic disc pigmentation, possibly a congenital anomaly (melanin deposition of optic nerve) associated with POAG.

The coexistence of these two clinical entities requires appropriate long-term monitoring to detect progression of either conditions. Serial fundus photographs would be helpful in monitoring the optic disc appearance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Brodsky MC, Buckley EG, Mc Conkie-Rosell A. The case of the gray optic disc! Surv Ophthalmol 1989;33:367-72.  Back to cited text no. 1
Neely K, Mets MB, Wong P, Szego K. Ocular findings in partial trisomy 10q syndrome. Am J Ophthalmol 1988;106:82-7.  Back to cited text no. 2
Thung E, Foroozan R. A pigmented optic disc. J Neuroophthalmol 2011;31:151-2.  Back to cited text no. 3
Bassi ST, George R, Sen S, Asokan R, Lingam V. Prevalence of the optic disc anomalies in the adult South Indian population. Br J Ophthalmol 2019;103:94-8.  Back to cited text no. 4
Reese AB. Pigmentation of the optic nerve. Trans Am Ophthalmol Soc 1932;30:338-43.  Back to cited text no. 5


  [Figure 1], [Figure 2]


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