An optic nerve that exits the eye superiorly (Fig. 13.5) is referred to as a tilted disk. The superior circumference of the margin of the optic disk will be obscured in a manner similar to oblique entry of the optic nerve. A number of other changes may also be observed, including an inferior crescent, situs inversus of the retinal vessels, ectasia of the fundus, myopia, and visual field defects. These findings may occur in various combinations and are referred to collectively as tilted-disk syndrome. This is clinically highly significant as nasal inferior ectasia of the fundus can produce temporal superior visual field defects. Where these findings are bilateral, care should be taken to distinguish them from pituitary tumors. This clinical picture is regarded as a form of rudimentary coloboma.
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