Peripapillary Hyperreflective Ovoid Mass-Like Structure (PHOMS): The Ovoids We Keep Missing

Background: Peripapillary hyperreflective ovoid mass-like structure (PHOMS) is a relatively new phenomenon most recently defined as an independent entity between 2015-2018. Histopathologically, PHOMS is described as a lateral protrusion of dilated axons into the peripapillary region as they exit the lamina cribrosa. These fibers are at the level of Bruch’s membrane opening as the optic nerve enters the optic globe proper. The identification of PHOMS is dependent upon optical coherence tomography (OCT) and its effects may be seen on a humphrey visual field (HVF). Case Report: The following case report reviews an incidental finding of PHOMS in a 43-year-old male whose optic nerve appeared small and crowded, with slightly blurred disc margins on dilated fundus examination. Conclusion: Eye care providers should be aware of PHOMS as a newly distinguished entity and its association with other disease entities. Dilated eye exams are important even when patients are asymptomatic. Such incidental findings should be monitored for progression or complications and baseline imaging should be captured.