An 8-year-old male patient was referred to our clinic with a suspicion of papilledema. The patient did not have headache. On examination, the best corrected visual acuity was evaluated as 20/20 with -2.5 D myopic correction in both eyes. The anterior segment examination was normal. Intraocular pressure was within normal limits. Fundus examination revealed elevated optic discs with obscured margins in both eyes. The macula and peripheral retina appeared normal. Multimodal imaging was performed on the patient.
In color fundus photos, the elevation of the entire nerve head appeared. Nasal borders were obscured.
Fundus auto-fluorescence imaging showed no hyperautofluorescence areas, whereas optical coherence tomography (OCT) revealed bilateral optic disc elevation due to a hyperreflective ovoid mass in the nasal peripapillary region.
The retinal layers are displaced upward and laterally due to the hyperreflectivity observed in the peripapillary region on OCT.
The patient was diagnosed with Peripapillary Hyperreflective Ovoid Mass-Like Structures (PHOMS) accompany myopia. The patient observed for month; RNFL thickness and condition did not change. The patient did not have headache. Papilledema secondary to increased ICP diagnosis was excluded.
PHOMS, or Peripapillary Hyperreflective Ovoid Mass-like Structures, are oval-shaped, highly reflective formations seen around the optic nerve head on OCT imaging. They can sometimes be mistaken for papilledema or other optic nerve disorders, but do not necessarily indicate a distinct disease on their own. PHOMS reflect changes in the nerve fiber layer near the optic disc and may create an appearance similar to optic nerve swelling. Correct identification is important to avoid unnecessary invasive procedures.
In FAF, Optic Disc Drusen (ODD) appears as highly hyperreflective, often buried calcified bodies within the optic nerve head, whereas PHOMS present as hyperreflective, ovoid masses around the optic disc margins, without calcifications.
In conclusion, PHOMS represent a frequent yet nonspecific sign on OCT, indicating disrupted axoplasmic flow within the optic nerve head. They are distinct from optic disc drusen (ODD) and do not serve as precursors to ODD, although they may coexist with ODD and various other disorders. Their presence does not rule out papilledema and is commonly found alongside it.
Credit: M. Giray Ersoz, MD, FEBO
Biruni University School of Medicine, Department of Ophthalmology, Istanbul, Turkey
Instagram accounts: @retina.review and @retina.dr.girayersoz
and Sepideh Lotfi, MD
Biruni University School of Medicine, Department of Ophthalmology, Istanbul, Turkey
Instagram accounts: @sepidls