Peripapillary Hyperreflective Ovoid Mass-Like Structure as an Optic Disc Pseudo-Edema Case Report and Review

The peripapillary hyperreflective ovoid mass-like structure (PHOMS) has been defined by the Optic Disc Drusen Studies (ODDS) Consortium as a distinct finding separate from the optic disc drusen (ODD). Given that PHOMS is neither a precursor nor subtype of ODD, its role as an independent risk factor for optic nerve diseases and its secondary consequences on nerve fibre function remain unclear.

We present the case of a 12-year-old child diagnosed with PHOMS. Multimodal ophthalmic imaging, including optical coherence tomography (OCT), revealed a peripapillary hyperreflective ovoid mass without calcification and elevated disc margins, but no signs of increased intracranial pressure or subretinal fluid, thereby distinguishing PHOMS from papilledema. Visual acuity was preserved, and no neurological abnormalities were detected.

This case illustrates important clinical and imaging distinctions between PHOMS and papilledema, emphasising the need for dedicated examination of PHOMS across disease groups. Longitudinal studies involving larger cohorts are warranted to determine whether PHOMS can serve as a biomarker for the magnitude and severity of optic nerve damage.