To report a case of glaucoma suspect with peripapillary pit, which enlarged in size with retinal herniation through the pit, and resulted in retinal nerve fiber layer defect and corresponding visual field defect.

A 34-year-old male was referred to our glaucoma clinic for glaucoma evaluation. The intraocular pressure was 15 mmHg in the right eye and 14 mmHg in the left eye. The refractive error in spherical equivalence was −12.75 diopters (D) in the right eye and −11.50 D in the left eye. The axial length was 28.70 mm in the right eye and 28.15 mm in the left eye. On optical coherence tomography (OCT), the retinal nerve fiber layer thickness was within normal limits in both eyes. A peripapillary pit was found in both eyes, which measured 155 µm in the right eye and 625 µm in the left eye in maximal horizontal diameters. Two year follow-up OCT images showed that the peripapillary pit in the right eye enlarged to 239 µm and retinal herniation occurred through the pit, resulting in a retinal nerve fiber layer defect and a corresponding visual field defect. However, the peripapillary pit in the left eye had no significant change.

Glaucoma patients or suspects, with peripapillary pits need close observation because of the possibility of a retinal nerve fiber layer defect in the direction of the pit.