In a patient with a tilted disc, often the superior pole of the optic disc appears elevated, with posterior displacement of the inferior nasal disc. Alternatively, the disc is tilted horizontally, resulting in an oval disc with an oblique long axis (Fig 26-8). Tilted disc is often associated with a scleral crescent located inferiorly or inferonasally, situs inversus, posterior ectasia of the inferior nasal fundus, and myopia and astigmatism.
Figure 26-7 Myelinated nerve fibers of the optic nerve and retina, right eye.
Figure 26-8 Tilted disc, right eye.
Patients may demonstrate superotemporal visual field defects, which may resolve with refractive correction. Tilted discs, myopic astigmatism, bilateral decreased vision, and visual difficulty at night suggest the possibility of X-linked congenital stationary night blindness (see Chapter 25). Acquired tilted disc and peripapillary crescent formation have been documented in children with myopic progression.
Kim TW, Kim M, Weinreb RN, et al. Optic disc changes with incipient myopia of childhood. Ophthalmology. 2012;119(1):21–26.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.