Tilted Optic Disc and Peripapillary Hyper-reflective Ovoid Mass-Like Structure

Abstract

An 11-year-old healthy girl was seen for a routine examination. Visual acuity was 20/20 both eyes. Refraction was –2.25 in the right eye and –0.50 in the left eye. Fundus examination was notable for an indistinct nasal optic disc margin with elevation in the right eye only (Fig A-B). OCT demonstrated a hyper-reflective signal in the nasal portion of the right optic disc (Fig C, arrow). Peripapillary hyper-reflective ovoid mass-like structures (PHOMS) is believed to represent axoplasmic stasis. Aside from being associated with a tilted optic disc, PHOMS can be observed in papilledema, anterior ischemic optic neuropathy, optic neuritis, and central retinal vein occlusion (Magnified version of Fig A-C is available online at www.aaojournal.org).