Cupping and pallor of the optic disc Cupping and pallor of the optic disc. A 45-year-old woman described gradual vision loss in her left eye. The patient was previously diagnosed with glaucoma in the left eye, but did not have elevated intraocular pressures. Visual acuity was 20/20 in the right eye, and CF 4' in the left eye. (A) Goldmann perimetry from the left eye shows a dense central scotoma with superior visual field loss that respects the horizontal meridian, consistent with an optic nerve–related visual field defect. However, a central scotoma would be most unusual for glaucoma. The visual field in the right eye was normal (not pictured). (B) The right optic disc is normal, with a cup-to-disc ratio of 0.6. The left eye has a cup-to-disc ratio of 0.8, which seems compatible with the diagnosis of glaucoma. However, not only is the optic disc cupped, but the neuroretinal rim is pale, raising further suspicions that glaucoma may not be the correct diagnosis. (C) The presence of a central scotoma and optic disc pallor with cupping raised concerns for a compressive optic neuropathy and led to neuroimaging. Magnetic resonance imaging (MRI; coronal T1 with contrast is pictured) was consistent with a planum sphenoidale meningioma compressing the prechiasmatic left optic nerve. Source: Optic Nerve Disorders, Practical Neuroophthalmology Citation: Martin TJ, Corbett JJ. Practical Neuroophthalmology; 2013 Available at: https://neurology.mhmedical.com/DownloadImage.aspx?image=/data/books/1041/martin_ch4_fig39.jpeg&sec=59022801&BookID=1041&ChapterSecID=59021899&imagename= Accessed: November 07, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved