Mechanical optic neuropathy in high myopia: Mechanical optic neuropathy in high myopia Bontzos, Plainis, Papadaki, Giannakopoulou and Detorakis

Myopia is a major cause of visual impairment and its prevalence is increasing globally at an alarming rate. High pathologic myopia is described as myopia with associated degenerative changes in the sclera, choroid and retinal pigment epithelium, resulting initially in loss of visual acuity (VA). Excessive elongation of the globe and posterior staphyloma are the hallmark findings in pathological myopia leading to mechanical damage to the retina and the optic nerve as a result of global stretching. Lacquer cracks, representing mechanical breaks of Bruch’s membrane are a typical manifestation of mechanical stretching in high myopic eyes. Moreover, papillary and peripapillary regions are often distorted because of the mechanical stress caused by an elongated myopic eye causing tilted optic discs and acquired megalodiscs. This report describes a case of a 43-yearold Caucasian man with pathological myopia who reported decreased vision in his right eye after an airplane landing. Imaging and clinical workup revealed excessive globe elongation potentially leading to optic nerve dysfunction.