Optic Nerve Mass and Retinal Traction in a 66-Year-Old Woman

Lauren L. Richards, OD; Case Series Editor: Jean Marie Pagani, OD


April 30, 2013

Clinical Presentation

A 66-year-old black woman presented for a comprehensive eye examination. Her systemic history was remarkable for diabetes mellitus, hypertension, hypercholesterolemia, and asthma, for which she was appropriately medicated. She denied any history of ocular trauma, ocular surgery, or inflammation.

Examination findings included the following:

  • Best-corrected visual acuity: 20/15 OD and 20/15 OS

  • Pupil testing and extraocular motilities: normal

  • Confrontation fields: inferior field defect OD and normal field OS

  • Slit-lamp examination of the anterior segment: corneal arcus OU and grade 1 nuclear sclerosis OU

  • Intraocular pressures (by Goldmann applanation tonometry): 11 mm Hg OD and 12 mm Hg OS

  • Blood pressure: 140/86 mm Hg right arm sitting

A dilated fundus examination of the right eye showed an elevated white lesion involving the superior aspect of the optic nerve head. A gliotic epiretinal membrane covered the lesion, causing visible traction lines within the adjacent retinal tissue. The left fundus was unremarkable, with a healthy and distinct optic nerve appearance.

Optical coherence tomography (OCT) was performed. The right eye showed an elevated mass of disorganized retinal tissue, with hyporeflective shadowing of the outer retina and overlying epiretinal membrane. The left eye showed normal optic nerve contour along with an anomalous posterior vitreous detachment (Figure 1). Humphrey automated visual field testing revealed a repeatable dense inferior arcuate defect in the right eye and normal fields in the left eye (Figure 2).

Figure 1. A. Elevated white lesion involving the optic nerve with retinal traction, right eye. B. Healthy fundus, left eye. C. Left: Horizontal OCT section, right eye, showing retinal elevation, disorganization, and epiretinal membrane. Right: Horizontal OCT section, left eye, showing anomalous posterior vitreous detachment with otherwise normal nerve appearance.

Figure 2. Humphrey visual field of the right eye showing a dense inferior arcuate defect.