CLINICAL PRACTICE Clinical Images Coloboma of the Optic Disc and Retina Paul B. Aronowitz, MD 1 and Jody K. Judge, MD 2 1 Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA; 2 Ophthalmic Consultants of Boston, Cambridge, MA, USA. KEY WORDS: clinical image; diagnosis; ophthalmology; neurology. J Gen Intern Med 32(10):1160 DOI: 10.1007/s11606-017-4052-8 © Society of General Internal Medicine 2017 A 20-year-old man without significant past medical histo- ry presented for routine eye examination. He had recent- ly noticed difficulty with distance vision and was found to have mild symmetric myopia. Best-corrected visual acuity was 20/20 in each eye. A slit lamp examination revealed a normal left optic fundus (Fig. 1). Exam of the right eye revealed an optic disc coloboma (Fig. 2, small arrow) and two retinochoroidal colobomas (Fig. 2, large arrows). An ocular coloboma is a congenital abnormality caused by failed closure of the embryonic or choroidal fissure during fetal development, and can occur in the eyelid, iris, lens, retina or optic nerve. 1 If the defect extends to the central region of the retina or optic nerve, vision may be impaired. Colobomas can be unilateral or bilateral and may be associated with a variety of ocular complications, including amblyopia and refractive error. Retinochoroidal colobomas may cause choroidal neo- vascularization (CNV) and retinal detachment. The patient returned for visual field testing, which showed a superotemporal defect, correlating with the inferior optic disc coloboma. He was advised to follow up for yearly eye exams to monitor for early signs of CNVor retinal detachment. Corresponding Author: Paul B. Aronowitz, MD; Department of Internal MedicineUniversity of California, Davis School of Medicine, Sacramento, CA, USA (e-mail: [email protected]). Compliance with Ethical Standards: Conflict of Interest: The authors declare that they do not have a conflict of interest. Funding: None. REFERENCES 1. Pagon RA. Ocular coloboma. Surv Ophthalmol. 1981;25(4):223–36. Figure 1 Left eye (normal). Figure 2 Right eye illustrating optic disc coloboma (small arrow) and two retinochoroidal colobomas (large arrows). Received December 28, 2016 Revised January 20, 2017 Accepted March 16, 2017 Published online March 28, 2017> 1160 JGIM

Coloboma of the Optic Disc and Retina - Springer · An ocular coloboma is a congenital abnormality caused by failed closure of the embryonic or choroidal fissure during fetaldevelopment,andcanoccurintheeyelid,iris,lens,retina

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Page 1: Coloboma of the Optic Disc and Retina - Springer · An ocular coloboma is a congenital abnormality caused by failed closure of the embryonic or choroidal fissure during fetaldevelopment,andcanoccurintheeyelid,iris,lens,retina

CLINICAL PRACTICEClinical ImagesColoboma of the Optic Disc and RetinaPaul B. Aronowitz, MD1 and Jody K. Judge, MD2

1Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA; 2Ophthalmic Consultants of Boston,Cambridge, MA, USA.

KEY WORDS: clinical image; diagnosis; ophthalmology; neurology.J Gen Intern Med 32(10):1160

DOI: 10.1007/s11606-017-4052-8

A 20-year-old man without significant past medical histo-ry presented for routine eye examination. He had recent-

ly noticed difficulty with distance vision and was found tohave mild symmetric myopia. Best-corrected visual acuitywas 20/20 in each eye.A slit lamp examination revealed a normal left optic fundus

(Fig. 1). Exam of the right eye revealed an optic disc coloboma(Fig. 2, small arrow) and two retinochoroidal colobomas(Fig. 2, large arrows).An ocular coloboma is a congenital abnormality caused by

failed closure of the embryonic or choroidal fissure duringfetal development, and can occur in the eyelid, iris, lens, retinaor optic nerve.1 If the defect extends to the central region of theretina or optic nerve, vision may be impaired. Colobomas canbe unilateral or bilateral and may be associated with a variety

of ocular complications, including amblyopia and refractiveerror. Retinochoroidal colobomas may cause choroidal neo-vascularization (CNV) and retinal detachment. The patientreturned for visual field testing, which showed asuperotemporal defect, correlating with the inferior optic disccoloboma. He was advised to follow up for yearly eye examsto monitor for early signs of CNVor retinal detachment.

Corresponding Author: Paul B. Aronowitz, MD; Department ofInternal MedicineUniversity of California, Davis School of Medicine,Sacramento, CA, USA (e-mail: [email protected]).

Compliance with Ethical Standards:

Conflict of Interest: The authors declare that they do not have aconflict of interest.

Funding: None.

REFERENCES1. Pagon RA. Ocular coloboma. Surv Ophthalmol. 1981;25(4):223–36.

Figure 1 Left eye (normal).

Figure 2 Right eye illustrating optic disc coloboma (small arrow) andtwo retinochoroidal colobomas (large arrows).

Received December 28, 2016Revised January 20, 2017Accepted March 16, 2017Published online March 28, 2017>

1160

JGIM

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