Case 63

Contributors: Marko Tien (Medical Student) and Dr. Amrit Rai

Patient Presentation: An 11-year-old male was referred to ophthalmology for an abnormal retinal lesion in the left eye. The patient is asymptomatic. Visual fields are normal, and BCVA is 20/20 OU. Fundus exam was performed and is shown below: 


Question: Where is the lesion in this eye?

OCT was performed over the lesion and shown below.


Question: What is the abnormality seen in the OCT?

Question: Based on the imaging and exam findings, what is the most likely diagnosis?

Question: What is the prognosis of a patient who presents with dark-without-pressure lesions?


  1. Fawzi, A. A., Nielsen, J. S., Mateo-Montoya, A., Somkijrungroj, T., Li, H. K., Gonzales, J., Mauget-Faÿsse, M., & Jampol, L. M. (2014). Multimodal imaging of white and dark without pressure fundus lesions. Retina (Philadelphia, Pa.), 34(12), 2376–2387.

  2. Flores Pimentel, M.A., Duncan, J.L., de Alba Campomanes, A.G. et al. (2021). Dark without pressure retinal changes in a paediatric age group. Eye 35, 1221–1227.

  3. Gupta, Gaurav & Bajgai, Priya & Singh, Ramandeep. (2018). Dark-Without-Pressure Fundus Lesions.

  4. Nagpal, K. C., Goldberg, M. F., Asdourian, G., Goldbaum, M., & Huamonte, F. (1975). Dark-without-pressure fundus lesions. The British journal of ophthalmology, 59(9), 476–479.

  5. Rafieetary, M. (Feb 2021). Navigating the Retinal Periphery. Review of optometry (eJournal). Accessed on Nov 12, 2021:

  6. Strohbehn A. Sohn EH. Retinal Detachment: From One Medical Student to Another. October 15, 2013; available from

Learning Objectives:

  1. Identify the funduscopic presentation and OCT findings of dark-without-pressure lesions.

  2. Understand the clinical significance and prognosis of dark-without-pressure lesions