A patient with blurry, distorted vision. What could it be?
A 48-year-old man presented to the clinic with complaints of blurry, distorted vision that had been present in the left eye for 6 months. The patient had no pertinent ocular history. His medical history was positive for seasonal allergies, for which he was taking Claritin (loratadine, Bayer) daily.

The patient’s best corrected visual acuities were 20/20 OD and 20/50 OS. He had normal extraocular motilities, and confrontation visual fields were full to finger counting in both eyes. IOP measured with Tono-Pen (Reichert) was 16 mm Hg OD and 16 mm Hg OS.

Anterior segment findings were normal in both eyes. The posterior segment of the right eye was normal. The macula in the left eye was thickened with a cystic appearance, and the optic nerve in the left eye had an abnormal appearance. An OCT image encompassing the optic nerve, macula and papillomacular macular bundle was obtained to determine the etiology of macular thickening and to better characterize the optic nerve abnormality.

OCT imaging revealed macular schisis extending through the papillomacular bundle to the temporal optic nerve. OCT scans over the optic nerve revealed a cavity within the optic nerve and overlying hyper-reflective membrane within the cup.

The patient was diagnosed with optic disc pit maculopathy (ODPM). Optic disc pits are rare congenital abnormalities affecting less than 0.20% of the population (Healey et al.). They often occur temporally and appear as gray pits within the disc. While most remain a benign finding, complications can spontaneously arise such as serous retinal detachment or macular schisis.

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