Cupped disc with normal intraocular pressure: The long road to avoid misdiagnosis

Abstract

We present a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway. Even though uncommon, compression of the anterior visual pathway is an important differential diagnosis of NTG. Diagnosis of NTG should be by exclusion. Here the possible causes of misdiagnosis are discussed. We present an approach to distinguish glaucomatous from nonglaucomatous optic neuropathy. The article also emphasizes how important it is for the clinicians to consider the total clinical picture, and not merely the optic disc morphology, to avoid the mismanagement of glaucoma, especially the NTG.

Keywords

• Myopia
• prethreshold retinopathy of prematurity
• retinopathy of prematurity
• Retinopathy of prematurity
• screening
• survey
• Anthrax
• community-acquired methicillin-resistant Staphyloccus aureus
• orbital cellulitis
• preseptal cellulitis
• Intrastromal corneal ring segments; keraring; post-LASIK ectasia
• Blebitis
• bleb leak
• microbiology
• ocular surface diseases
• risk factors
• Early glaucoma
• retinal nerve fiber layer thickness
• spectral optical coherence tomography / scanning laser ophthalmoscope
• Blowout
• diplopia
• prism
• strabismus
• Ocular trauma
• open globe injury
• preoperative visual acuity
• prognostic factors
• relative afferent pupillary defect
• Anterior chamber depth
• axial length
• lens thickness
• phacomorphic glaucoma
• risk factor
• Refractive errors
• Schoolgirls
• visual impairments
• Cataract
• intraocular lens
• monovision
• presbyopia
• pseudophakic
• Accommodative esotropia
• atropine
• cycloplegia
• esotropia
• Optic disc cupping
• optic disc pallor
• suprasellar tumor
• glaucoma
• neuroimaging