Diagnosis of Large Papillary Excavations in Developing Countries: From Automated Visual Field to OCT of the Ganglion Complex. About a Case

Background: Large papillary excavations constitute a true differential diagnosis of glaucoma in our environments. Aim: To present a clinical case of large papillary excavation simulating glaucomatous optic neuropathy in a young subject. Case Presentation: The ophthalmologic examination made it possible to note a visual acuity of LogMar 0.00, ocular hypertonia and a large papillary excavation in both eyes. The visual field noted bilateral perimetric involvement suggesting optic neuropathy. Optical coherence tomography (OCT) of the ganglion complex revealed an absence of involvement of the ganglion complex and the ganglion ridge essential to evoke optic neuropathy. An ocular hypotonizing treatment made it possible to normalize the intraocular pressure. Conclusion: The particularity of this observation lies in the fact that the perimeter involvement that preceded any involvement can simulate a glaucomatous involvement. Functional damage to the visual field must be correlated with structural damage to suggest glaucomatous damage in our ophthalmic patients.