Abstract
Background: Large papillary excavations constitute a true differential diagnosis of glaucoma in our environments. Aim: To present a clinical case of large papillary excavation simulating glaucomatous optic neuropathy in a young subject. Case Presentation: The ophthalmologic examination made it possible to note a visual acuity of LogMar 0.00, ocular hypertonia and a large papillary excavation in both eyes. The visual field noted bilateral perimetric involvement suggesting optic neuropathy. Optical coherence tomography (OCT) of the ganglion complex revealed an absence of involvement of the ganglion complex and the ganglion ridge essential to evoke optic neuropathy. An ocular hypotonizing treatment made it possible to normalize the intraocular pressure. Conclusion: The particularity of this observation lies in the fact that the perimeter involvement that preceded any involvement can simulate a glaucomatous involvement. Functional damage to the visual field must be correlated with structural damage to suggest glaucomatous damage in our ophthalmic patients.
Highlights
Optical coherence tomography (OCT) of the ganglion complex revealed an absence of involvement of the ganglion complex and the ganglion ridge essential to evoke optic neuropathy
Glaucoma is a progressive optic neuropathy manifested by abnormalities of the optic papilla and subsequent alterations in the visual field [2]
Glaucomatous alterations are constituted by a progression of the papillary excavation with a characteristic appearance, a deficit in the visual field survey reflecting the attack of the ganglion cells highlighted on tomography in optical coherence
Summary
Very globally, based on data from a meta-analysis published in 2006, the prevalence of POAG is higher in the black population, intermediate in Caucasians and Hispanics, and low in some Asian populations. Large papillary excavations constitute a differential diagnosis of large glaucomatous excavation in our settings, forcing the clinician to resort to more advanced paraclinical examinations in order to make the diagnosis. Through this observation, we present a case of large excavation with the perimeter survey of lesions simulating from the outset an optic neuropathy. The OCT noted an absence of lymph node cell involvement, confirming that this is a large physiological papillary excavation
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