Peripapillary Schisis With Sensory Detachment in Advanced Glaucoma

Introduction. A case of juxtapapillary retinal schisis-like cavities associated with underlying serous detachment in a normal tension glaucoma patient is described. Case Presentation. A normal tension glaucoma patient with enlarged optic nerve cupping was observed to have temporally localized juxtapapillary serous retinal detachment OD. Optical coherence tomography (OCT) demonstrated an area of retinal schisis-like cavities with underlying serous detachment contiguous to the temporal disc margin. Presence of an atypical coloboma or optic nerve head pit was not observed during biomicroscopy, OCT or using Heidelberg retinal tomography (HRT). This presentation occurred in the absence of an atypical optic nerve coloboma, congenital or acquired optic nerve head pit. The juxtapapillary retinal schisis-like cavities resolved spontaneously. Deviation From the Expected. Few cases involving a similar presentation in glaucoma, exhibiting spontaneous resolution has been documented in literature. Discussion. Retinal schisis-like compartments with underlying serous detachment may develop in individuals with advance glaucomatous cupping independent of elevated intra ocular pressure or presence of an atypical coloboma or optic nerve head pit. Conclusion. A mechanism similar to that postulated for the development of optic nerve pit associated foveolar schisis and central serous detachment (CSD) may be responsible for this analogous presentation in advance glaucoma. Microscopic pores located at the inner limiting membrane, between the optic nerve, subarachnoid space and retina may provide an interconnecting access for fluid passage into the retina.