Tilted-Disc Syndrome

April 2, 2005
Leonid Skorin, Jr, DO
Leonid Skorin, Jr, DO

A 32-year-old woman complained of increased blurring of her distance vision. Results of a refraction showed that she had worsening myopia in both eyes. An increase in her prescription corrected her visual acuity to 20/20 in both eyes.

Case 5:
Tilted-disc Syndrome

A 32-year-old woman complained of increased blurring of her distance vision. Results of a refraction showed that she had worsening myopia in both eyes. An increase in her prescription corrected her visual acuity to 20/20 in both eyes.

The rest of her ocular examination was unremarkable except for the appearance of the optic nerve heads (A and B). The patient had tilted discs, which result from the oblique insertion of the optic nerve into the globe. The discs are often small and oval or D-shaped, with the axis directed obliquely. Sometimes, as in this patient, the axis is horizontal. In about 80% of patients, the condition is bilateral.1 Nasal sweeping of the retinal vessels (situs inversus), inferonasal fundus hypopigmentation from thinning of the retinal pigment epithelium and choroid, and a rim of exposed sclera known as a crescent can often be seen inferiorly (A). Most patients with this condition are myopic or have oblique astigmatism. Visual field defects that mimic superior bitemporal hemianopsias may occur as a result of the inferonasal fundus changes. Because tilted-disc syndrome is a stationary condition, the prognosis is good.