To the Editor,
A 48-year-old male was referred to the glaucoma clinic for optic disc evaluation. There were no ocular or systemic abnormalities. His visual acuity was 20/20 in both the eyes. Slit-lamp biomicroscopy of the anterior segment was normal and showed no evidence of conjunctival or scleral pigmentation. The right eye showed a medium-sized optic disc with well-defined scleral borders, 0.6 cup–disc ratio (CDR), and uniform, homogenous sectoral pigmentation, from 10 to 1 clock hour [Figure 1]. The neuroretinal rim was intact, and the rest of the disc was pink in color. Alpha and beta zone was noted temporally and the surrounding retina was normal with no evidence of pigmentation elsewhere. The left eye fundus was normal with a medium-sized optic disc and 0.6 CDR and healthy neuroretinal rim.
A diagnosis of benign pigmentation of the optic disc was made. The condition was documented and the patient was asked to come for an annual eye examination.
Disc pigmentation is rare and can be primary or secondary. Patients in the primary group often have associated ocular abnormalities such as disc hypoplasia, nystagmus, ptosis, ocular albinism, or chromosomal abnormalities.[1,2] Secondary pigmentation of the optic disc may be caused by melanocytoma or hemorrhage. We have reported a case of benign pigmentation of the disc in association with primary open-angle glaucoma.
On review of the literature, I did not find photographic documentation of benign sectoral pigmentation of the disc. This is one of the cases, in which optic disc pigmentation was an isolated finding and was restricted to the superior neuroretinal rim. In our patient, optic discs were of medium size, in contrast to the literature search, in which usually pigmented discs are described in patients with small disc size.[1,3]
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1. Brodsky MC, Buckley EG, McConkie-Rosell A. The case of the gray optic disc! Surv Ophthalmol. 1989;33:367–72
2. Neely K, Mets MB, Wong P, Szego K. Ocular findings in partial trisomy 10q syndrome Am J Ophthalmol. 1988;106:82–7
3. Mansoori T, Agraharam SG. A pigmented disc in glaucoma! Indian J Ophthalmol. 2020;68:2225–6