BACKGROUND

It is not clear whether doubling of the papilla occurs in connection with congenital ocular malformations or whether there is a double anlage of a real papilla. A double optic nerve close to the globe has never been observed.

METHODS

A 87-year old woman had high-grade myopia and amblyopia of her right eye together with an esotropia from early childhood. The right eye had a cataract. Some time ago she experienced a bilateral incomplete infarction of the territory of the posterior cerebral artery. The visual acuity of her right eye was 1/50. The Goldmann visual field showed a concentric constriction with the V/4 test mark.

RESULTS

The right fundus revealed a double configuration of a papilla, in addition to widespread myopic changes due to extension of the retina and choroid at the posterior eye pole. The two papillae were located one upon another and the slightly smaller pseudopapilla was found temporal beneath to the true papilla. The papillae had central vessels, well supplied with blood, and with distributions into temporal and nasal tributaries. The big vessels of both papillae were not connected. The MRI revealed only one optic nerve of normal appearance.

CONCLUSIONS

The findings in our patient demonstrate that a double papilla occurs without a double optic nerve. The smaller papilla occurred in an area of widespread myopic changes of the retina and choroid that we assume the appearance of a pseudopapilla. The site beneath the true papilla in an colobomatous area points to a developmental failure due to an incomplete closure of the optic cleft of the embryo. A secondary ingrow of vessels could have developed into the pseudopapilla during the embryonal period.