Lamellar Intraocular Ossification encasing the Optic Nerve Head: A Case Report

Abstract

Intraocular ossification is a rare end-stage sequela of chronic retinal detachment, inflammation, trauma, or phthisis bulbi. It typically presents as minor localised choroidal or retinal ossification. We report an exceptionally rare case of mature lamellar intraocular bone encasing the optic nerve head.
A 23-year-old male presented three days after sustaining a knife injury to the right eye. The eye had been blind with no light perception for approximately five years prior, with a history of longstanding visual impairment since childhood. Examination revealed an open globe with corneal-limbal laceration and prolapse of uveal and lenticular tissue. The open-globe injury and extensive tissue prolapse precluded posterior segment assessment and B-scan ultrasonography.  The contralateral eye demonstrated a morning glory disc anomaly with a shallow chronic retinal detachment, which was treated conservatively.
During routine evisceration, a near-round 12 mm lamellar bony mass was identified encasing the optic nerve head, forming a central invagination in which the optic nerve was seated. The mass felt like bone and was non-adherent; it was removed intact. Post-operative CT imaging showed no additional intra-orbital ossification or malignancy. Histopathology demonstrated mature lamellar bone with osteoblastic rimming, marrow spaces containing adipocytes, and psammomatous calcifications, consistent with long-standing heterotopic ossification. No malignant features or organisms were identified.
The postoperative course was uncomplicated, and the patient remained clinically well at six months’ follow-up. This case represents an exceptionally rare report of mature lamellar intraocular bone fully encasing the optic nerve head, highlighting the remarkable metaplastic potential of intraocular tissues in chronic retinal pathology.