Peripapillary Hyperreflective Ovoid Mass-Like Structures (PHOMS)

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a pattern doctors see on a special eye scan called optical coherence tomography (OCT). They sit next to the optic nerve head (the “disc,” where the nerve enters the eye), form a rounded/oval ridge under the retina, and look bright (hyper-reflective) on the scan. They often form a ring or C-shape hugging the disc edge. They are not a tumor and not a true mass—they are a shape change in nerve fibers and nearby tissues seen on imaging. Researchers now believe PHOMS most often show “axoplasmic stasis,” which means the flow of material inside crowded or swollen optic nerve fibers slows down and some fibers bulge sideways into the peripapillary retina. FrontiersPMC+1

Peripapillary hyperreflective ovoid mass-like structures—shortened to PHOMS—are special shapes that eye doctors can see on an OCT scan (a painless light-based “ultrasound” of the eye). On the cross-section picture, a PHOMS looks like a bright, oval bump sitting next to (peri- = around) the optic nerve head (the “disc,” where the nerve enters the eye). Although they look “mass-like,” they are not tumors and not true lumps. They are thought to form when nerve fibers near the disc become crowded and pushed sideways, creating a bulging, ovoid outline above the opening in the back of the eye (the Bruch’s membrane opening). In other words, PHOMS are a shape change of the nerve fiber layer, not a new growth. PMC+1

A key point: PHOMS are not the same thing as optic disc drusen (ODD). ODD are calcified deposits inside the optic nerve head that, on OCT, usually have a dark (hypo-reflective) core with a bright shell. PHOMS, in contrast, are bright, oval, peripapillary bands without that dark core and sit just outside the disc. This difference matters because ODD and true disc swelling (papilledema) are managed differently, and PHOMS can occur with either. PubMedRetina TodayLippincott Journals

Think of the optic nerve head as a busy roundabout where millions of nerve fibers leave the eye. If the roundabout is crowded (small disc), tilted (myopia), pushed (true swelling from high brain pressure), or compressed by deposits (drusen), the internal flow inside those fibers can slow. When that happens, some fibers herniate sideways into the peripapillary retina, creating the bright ovoid ridge OCT calls PHOMS. This is why PHOMS are described as a common but non-specific sign—they tell you there is traffic congestion in the nerve fibers, but not exactly why. PMC+1

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Types of PHOMS

Because PHOMS are an imaging sign, doctors usually classify them by context—what they are seen with. This keeps things simple and clinically useful.

1. PHOMS with optic disc drusen (ODD)
   These eyes have drusen inside the nerve head and a PHOMS ring outside the disc. Drusen may crowd fibers and contribute to lateral herniation. PMCLippincott Journals

2. PHOMS with papilledema (raised intracranial pressure)
   PHOMS can coexist with true optic disc swelling from high brain pressure and do not rule it out. In this setting, PHOMS track with the edema burden. PMC

3. PHOMS with myopic tilted disc / high myopia
   In growing children and young people, PHOMS have a strong link with increasing myopia and a tilted disc. The tilt may mechanically displace fibers. NatureReview of Optometry

4. PHOMS with ischemic optic neuropathy (NAION)
   Studies show PHOMS can appear in non-arteritic anterior ischemic optic neuropathy, sometimes signaling more severe edema, and may lessen as swelling resolves. Frontierstvst.arvojournals.org

5. PHOMS with inflammatory optic neuritis and other neuropathies
   Less common, but described in optic neuritis and Leber hereditary optic neuropathy (LHON). Presence and persistence vary. FrontiersPMC

6. PHOMS in otherwise healthy eyes (often pediatric)
   PHOMS can be found in healthy children (no drusen, no swelling) and are more frequent in those with myopia/tilt, so they should not be taken as automatic proof of disease. PubMed

7. PHOMS in “pseudopapilledema” evaluations
   In children referred for “swollen discs,” PHOMS are a frequent cause of a swollen-looking disc without true edema, helping avoid unnecessary invasive testing—but PHOMS can also coexist with real papilledema. PMC

8. Time-course: transient vs persistent
   PHOMS may appear de novo and sometimes resolve as the underlying swelling settles, or persist in chronically crowded discs/drusen. AAO

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Causes/associations that can lead to PHOMS

Because PHOMS signal axoplasmic stasis at the disc edge, anything that crowds, tilts, swells, or injures the optic nerve head can be associated. Below are widely reported contexts, with plain-English descriptions:

1. Optic disc drusen (ODD) – Calcified deposits crowd the small disc and nudge fibers sideways. PHOMS often accompanies ODD. PMC

2. Papilledema (raised brain pressure) – True swelling from high intracranial pressure thickens nerve fiber layers; PHOMS may ride along the disc edge. PMC

3. Myopic tilted disc – In myopia, the disc can tilt; fibers bend and bulge laterally, encouraging PHOMS. Nature

4. High myopia itself – Progressive elongation of the eye and disc changes correlate with PHOMS in kids. Review of Optometry

5. Non-arteritic anterior ischemic optic neuropathy (NAION) – Sudden poor blood flow causes swelling; PHOMS may indicate heavier edema load. Frontiers

6. Optic neuritis – Inflammatory swelling can produce PHOMS in a subset of cases. PMC

7. Leber hereditary optic neuropathy (LHON) – Mitochondrial dysfunction injures fibers; PHOMS has been reported in the disease spectrum. Frontiers

8. Crowded, small optic discs (anatomical) – A tiny scleral canal leaves little room for fibers; lateral bulging is more likely. PMC

9. Pseudopapilledema in children – The disc looks swollen, but it isn’t; PHOMS often explains the look. PMC

10. Prelaminar hyperreflective lines / micro-architectural disc changes – Structural signs of crowding/tilt that travel with PHOMS. Review of Optometry

11. Idiopathic intracranial hypertension (IIH) – A specific cause of papilledema; PHOMS may be present and must not be mistaken for benign changes. Review of Optometry

12. Diabetic papillopathy – Disc swelling related to diabetes can create the stasis signal PHOMS reflect. (Association discussed in broad PHOMS reviews.) Frontiers

13. Central retinal vein occlusion (CRVO) – Venous blockage can swell the disc—another path to PHOMS. PMC

14. Compressive optic neuropathies – Pressure on the nerve (rare) can slow axoplasmic flow and produce PHOMS-like changes. Frontiers

15. Neuroretinitis / posterior uveitis – Inflammation affecting the optic disc region may accompany PHOMS in some cases. Frontiers

16. Hyperopic, crowded discs in small eyes – The opposite of pathologic myopia; small crowded discs predispose to stasis. PMC

17. Post-edema remodeling – After any episode of disc edema, residual architecture may support persistent PHOMS. Frontiers

18. Healthy eyes (incidental) – Especially in kids; underscores PHOMS as a sign, not a diagnosis. PubMed

19. Tilted disc syndrome (TDS) without high myopia – A congenital tilt pattern alone can be enough for PHOMS. PMC

20. Mixed mechanisms (ODD + NAION, ODD + papilledema) – Two processes together further crowd fibers and increase PHOMS frequency. Frontiers

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Symptoms

PHOMS do not cause symptoms by themselves. Any symptom comes from the disorder behind them:

1. Headache (common in raised intracranial pressure/IIH). Lippincott Journals

2. Transitory dimming or “graying out” of vision (transient visual obscurations in papilledema). Lippincott Journals

3. Blurred or fluctuating vision (edema, neuritis, vein occlusion). PMC

4. Enlarged blind spot (papilledema or ODD-related field change). Lippincott Journals

5. Peripheral visual field defects (ODD/NAION can cause arcuate or nasal defects). Lippincott Journals

6. Sudden, painless central or altitudinal vision loss (NAION). Frontiers

7. Eye pain worsened by movement (optic neuritis). PMC

8. Color desaturation (especially red looks washed out) (optic neuritis/optic nerve dysfunction). Lippincott Journals

9. Photopsias or brief flashes (inflammatory/edematous states). Lippincott Journals

10. Diplopia (rare) from coexisting intracranial pressure problems affecting eye muscles. Lippincott Journals

11. Nausea/vomiting with high intracranial pressure. Lippincott Journals

12. Visual fatigue and difficulty with fine print (nerve dysfunction). Lippincott Journals

13. Night vision difficulties in some neuropathies. Lippincott Journals

14. No symptoms at all (incidental PHOMS, especially in children with tilt/myopia). PubMed

15. Intermittent “haze” or “fog” during position change (papilledema). Lippincott Journals

Reminder: these symptoms point to the cause. PHOMS simply help doctors see that something like edema, crowding, or tilt is present.

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Diagnostic tests

The goal is to identify the cause behind PHOMS, and to separate harmless look-alikes (pseudopapilledema) from true swelling (papilledema) or optic neuropathies. PHOMS themselves are made visible by OCT, but the full work-up is broader.

A) Physical exam (at the slit lamp or in the exam room)

1. Visual acuity (distance and near) – Measures how clearly you see to track impact of the underlying disease.

2. Pupil exam with swinging-flashlight test – Looks for a relative afferent pupillary defect (RAPD), which suggests optic nerve dysfunction.

3. Color vision (Ishihara or similar) – Subtle optic nerve problems often reduce red/green discrimination.

4. Confrontation visual fields – A bedside screen to catch large field defects that might need formal perimetry.

5. Dilated fundus examination – Direct look at the optic disc to judge true swelling vs. a crowded look, hemorrhages, and coexisting drusen.

(These steps are standard in distinguishing papilledema, neuritis, NAION, and ODD-related pseudopapilledema.) Lippincott Journals

B) “Manual” or simple office tests (low-tech, quick checks)

6. Amsler grid – A simple grid that helps you notice scotomas or distortions.

7. Red desaturation test – A red cap looks less red to an eye with optic nerve dysfunction.

8. Brightness comparison – Patients compare brightness between eyes; a dimmer view can hint at optic nerve disease.

9. Near contrast sensitivity card – Picks up low-contrast vision loss missed by high-contrast charts.

10. Formal automated perimetry (Humphrey/Octopus) – Not “manual” in the literal sense, but a non-imaging functional test that maps blind-spot enlargement and field loss typical of papilledema, ODD, or NAION. Lippincott Journals

C) Laboratory / pathological tests (chosen to match the suspected cause)

11. Lumbar puncture with opening pressure – The most direct way to confirm raised intracranial pressure in suspected IIH; done only when indicated. Lippincott Journals

12. ESR/CRP ± temporal artery work-up – In older adults with sudden vision loss where arteritic AION is a concern; rules out giant cell arteritis. Lippincott Journals

13. Autoimmune/infectious panels (e.g., ANA, ACE, syphilis, Lyme) – Targeted blood tests when inflammation or infection could be driving disc swelling. Lippincott Journals

14. Metabolic/vitamin studies (B12, thyroid) – Looks for systemic problems that can mimic optic neuropathies. Lippincott Journals

15. Genetic testing for LHON – Considered if the story fits a mitochondrial optic neuropathy, often in young adults. Frontiers

D) Electrodiagnostic tests (objective measures of optic nerve function)

16. Visual evoked potentials (VEP) – Measures speed/strength of signals from eye to brain; delayed or reduced responses suggest optic nerve dysfunction.

17. Pattern electroretinography (pERG) – Helps separate retinal from optic nerve causes of vision loss.

18. Multifocal VEP – Maps localized conduction problems across the field.

(These tests are supportive when the diagnosis is unclear or when corroborating optic nerve dysfunction matters.) Lippincott Journals

E) Imaging tests (the core of PHOMS diagnosis and its look-alikes)

19. OCT with Enhanced Depth Imaging (EDI-OCT) – The key test to see PHOMS. PHOMS show as bright ovoid bands round the disc and sit above the Bruch’s membrane opening; ODD display a dark core with a bright shell inside the disc. AjoPMCPubMed

20. Adjunct imaging when needed:
    • OCT-Angiography (OCTA) to look for flow within/around PHOMS and coexisting microvasculature changes.
    • Fundus autofluorescence (FAF) to highlight drusen, which often glow.
    • B-scan ultrasound to detect calcified drusen and assess the optic nerve sheath.
    • MRI/MRV brain and orbits when papilledema or other neurologic disease is suspected.
    • Color fundus photography / near-infrared reflectance to document ring-like peripapillary patterns and follow change over time. ScienceDirectOptometry Times

Non-pharmacological treatments

Important: There is no medicine or procedure that “treats PHOMS directly.” Care focuses on the underlying condition (for example, IIH or optic disc drusen) and on protecting vision. The options below are evidence-informed, practical, and safe when guided by your clinician.

1. Regular OCT and visual field monitoring
   Description: Scheduled OCT scans and visual field tests every few months at first, then as advised.
   Purpose: Track any change around the optic disc and detect early vision changes.
   Mechanism: Objective measurements catch small structural or functional shifts before you notice symptoms.

2. Education on red-flag symptoms
   Description: Learn warning signs: sudden or progressive vision loss, frequent brief “graying out,” new double vision, severe morning headaches, or pulsating noise in the ear.
   Purpose: Prompt care prevents permanent vision loss in conditions like papilledema.
   Mechanism: Early recognition → early treatment of the cause.

3. Weight-loss program for at-risk patients (especially with IIH)
   Description: Calorie-reduced diet, behavior support, and activity plan; sometimes supervised programs.
   Purpose: Weight reduction can lower intracranial pressure and improve papilledema.
   Mechanism: Less abdominal/venous pressure → improved cerebrospinal fluid (CSF) dynamics → less optic nerve swelling. Evidence from IIH trials supports diet as a core treatment. PMC

4. Low-sodium eating pattern
   Description: Aim for a low-salt diet (for example, <2–2.3 g sodium/day unless your clinician advises otherwise).
   Purpose: Complements IIH care; helps blood pressure and fluid balance.
   Mechanism: Lower sodium → less fluid retention → may support CSF pressure control as used in IIH trials. PMC

5. Aerobic physical activity most days of the week
   Description: Brisk walking/cycling 150–300 minutes/week, tailored to you.
   Purpose: Aids weight control, sleep quality, and headache prevention.
   Mechanism: Improves energy balance, autonomic tone, and vascular health.

6. Treat sleep apnea (testing and CPAP if indicated)
   Description: Screen for snoring, witnessed apneas, daytime sleepiness; use CPAP if diagnosed.
   Purpose: Sleep apnea can worsen IIH-like symptoms and headaches.
   Mechanism: CPAP reduces nighttime oxygen dips and venous congestion, potentially lowering optic nerve stress.

7. Head-of-bed elevation
   Description: Sleep with the head of bed elevated about 20–30°.
   Purpose: Some patients with raised intracranial pressure feel better in the morning.
   Mechanism: Gravity helps venous/CSF outflow overnight.

8. Avoid or review drugs that can raise intracranial pressure
   Description: With your doctor, review need for tetracyclines, vitamin-A derivatives (isotretinoin), high-dose vitamin A, growth hormone, and others.
   Purpose: Reduce medication-induced papilledema risk.
   Mechanism: Removing triggers lowers CSF pressure drivers.

9. Headache hygiene
   Description: Regular sleep, hydration, consistent caffeine, reduce screen glare, limit trigger foods, manage stress.
   Purpose: Lower headache burden that often accompanies IIH.
   Mechanism: Stabilizes pain pathways and vascular reactivity.

10. Outdoor time for children and smart near-work habits
    Description: ≥2 hours/day of outdoor light exposure when possible; 20-20-20 rule for reading/screens.
    Purpose: Supports myopia control; myopia and tilted discs are linked with PHOMS.
    Mechanism: Bright outdoor light and breaks slow myopia progression, indirectly lowering anatomic risk factors. PubMed

11. Posture and Valsalva avoidance
    Description: Avoid prolonged head-down yoga poses, heavy straining, or tight neck garments.
    Purpose: Reduces transient increases in intracranial and venous pressure.
    Mechanism: Less venous congestion around the optic nerve.

12. Smoking cessation
    Description: Counseling, nicotine replacement, or formal programs.
    Purpose: Protects small blood vessels that feed the optic nerve.
    Mechanism: Less oxidative stress and vasoconstriction.

13. Manage systemic blood pressure, glucose, and lipids
    Description: Work with your clinician on targets for BP, A1c, and cholesterol.
    Purpose: Supports optic nerve perfusion and overall eye health.
    Mechanism: Stable vascular supply protects nerve fibers.

14. Hydration balance (not too little, not too much)
    Description: Steady fluid intake; avoid large late-night salty meals.
    Purpose: Fewer fluid swings may help headache and morning symptoms.
    Mechanism: Smoother fluid status → steadier venous/CSF dynamics.

15. Blue-light and glare control
    Description: Adjust screens, use matte filters or room lighting.
    Purpose: Reduces eye strain in patients monitored closely with frequent near work.
    Mechanism: Lowers accommodative stress and discomfort.

16. Protective eyewear for contact sports
    Description: Use sports-rated goggles/helmets.
    Purpose: Prevents eye trauma that could complicate optic nerve problems.
    Mechanism: Reduces impact forces.

17. Cautious altitude and travel planning (for symptomatic IIH)
    Description: Discuss long flights or high altitude if you are unstable.
    Purpose: Avoid symptom flares.
    Mechanism: Pressure and fluid shifts can worsen headaches in some people.

18. Vision ergonomics at work/school
    Description: Good reading distance, proper monitor height, regular breaks.
    Purpose: Less visual fatigue and better compliance with follow-ups.
    Mechanism: Reduces accommodative load and strain.

19. Family screening when optic disc drusen run in the family
    Description: Simple fundus exam ± OCT in first-degree relatives when appropriate.
    Purpose: Early identification of disc anomalies that may coexist with PHOMS.
    Mechanism: Baseline data improves monitoring decisions. PMC

20. Scheduled follow-ups with a neuro-ophthalmologist when PHOMS are new or atypical
    Description: Specialist evaluation and co-management.
    Purpose: Ensure the right tests are done and nothing dangerous is missed.
    Mechanism: Expertise in differentiating pseudopapilledema from true papilledema. EyeWiki

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Drug treatments

There is no drug that removes PHOMS. Medicines are used only to treat the underlying condition that appears with PHOMS (most often IIH/papilledema, sometimes peripapillary choroidal neovascularization near disc drusen, or inflammatory optic neuropathies). Doses below are typical ranges—not personal medical advice. Always follow your doctor’s prescription.

1. Acetazolamide
   Class: Carbonic anhydrase inhibitor (systemic).
   Typical dose/time: 250–500 mg two to four times daily (many use 500 mg extended-release twice daily); start low and titrate.
   Purpose: First-line for IIH to reduce optic nerve swelling and protect vision.
   Mechanism: Lowers CSF production at the choroid plexus; may reduce disc edema.
   Key evidence/notes: In the IIH Treatment Trial, diet + acetazolamide improved visual function and papilledema more than diet alone. Common side effects: tingling in fingers, metallic taste, fatigue, kidney stones, low potassium, and rarely severe rash. PMCJNNP

2. Topiramate
   Class: Antiepileptic with weak carbonic anhydrase inhibition.
   Typical dose/time: 25–50 mg at night, titrated to 50–100 mg twice daily as tolerated.
   Purpose: Alternative or adjunct for IIH, especially when migraine is present and weight loss is desired.
   Mechanism: Mild CSF reduction, appetite suppression, and migraine prevention.
   Side effects: Cognitive slowing, tingling, taste change, kidney stones, mood changes; avoid in pregnancy without specialist advice. JNNP

3. Furosemide
   Class: Loop diuretic.
   Typical dose/time: 20–40 mg once or twice daily as an adjunct when acetazolamide alone is not enough.
   Purpose: Add-on therapy in IIH to aid fluid removal.
   Mechanism: Diuresis reduces total body fluid; may lower ICP indirectly.
   Side effects: Low potassium/sodium, dehydration, low blood pressure, hearing issues at high doses. JNNP

4. Methazolamide
   Class: Carbonic anhydrase inhibitor (systemic).
   Typical dose/time: 50–100 mg two to three times daily.
   Purpose: Option if acetazolamide is not tolerated.
   Mechanism: Same class effect—reduces CSF production.
   Side effects: Similar to acetazolamide but may be better tolerated in some.

5. Short-course high-dose corticosteroids (for optic neuritis or active inflammatory optic neuropathy—not for IIH)
   Class: Glucocorticoid (e.g., IV methylprednisolone), followed by a short oral taper in selected cases.
   Purpose: Quickly reduce optic nerve inflammation to protect vision.
   Mechanism: Potent anti-inflammatory and anti-edema effects.
   Side effects: Mood changes, high blood sugar, stomach upset, insomnia, and, with longer use, bone loss and infection risk. Not a treatment for IIH and may worsen weight gain.

6. Intravitreal anti-VEGF injection (ranibizumab)
   Class: Anti-VEGF biologic (intraocular).
   Typical regimen: Monthly injections initially, then as needed.
   Purpose: Treats peripapillary choroidal neovascularization (CNV) that can rarely occur near optic disc drusen.
   Mechanism: Blocks VEGF to stop leakage and bleeding from abnormal vessels.
   Side effects: Eye pain, floaters, very small risk of infection or retinal tear/detachment.

7. Intravitreal anti-VEGF injection (aflibercept)
   Class: Anti-VEGF biologic (intraocular).
   Typical regimen: Monthly then treat-and-extend per retina specialist.
   Purpose/mechanism/side effects: Same as above.

8. Mannitol (hospital use for acute raised intracranial pressure)
   Class: Osmotic agent (IV).
   Typical dose/time: Given in emergency settings under monitoring.
   Purpose: Temporarily lowers intracranial pressure in emergencies.
   Mechanism: Draws fluid out of brain tissue into blood.
   Side effects: Fluid/electrolyte shifts; requires strict monitoring.

9. Headache preventives when migraine coexists (e.g., propranolol, candesartan, amitriptyline—specialist-guided)
   Class: Varies.
   Purpose: Reduce headache frequency in patients with IIH + migraine.
   Mechanism: Modulates pain pathways or vascular tone.
   Side effects: Depend on drug; chosen individually.

10. Pain relievers for acute headache flares (e.g., NSAIDs used judiciously)
    Class: Non-steroidal anti-inflammatory drugs (OTC or prescription).
    Purpose: Short-term symptom relief.
    Mechanism: Blocks prostaglandins to reduce pain.
    Side effects: Stomach upset, kidney risk with heavy use; avoid medication-overuse headache.

Why only a few drugs are listed with strong evidence: For PHOMS-associated IIH, the best evidence is for acetazolamide combined with weight loss; other agents are used case-by-case. There is no proven medication to “shrink” PHOMS, because PHOMS is a shape change, not a disease by itself. PMCJNNP

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Dietary molecular supplements

Supplements do not treat PHOMS. They may support general eye and nerve health, migraine prevention, or weight goals. Always review supplements with your clinician, especially if you are pregnant, on blood thinners, or have kidney stones.

1. Omega-3 (EPA/DHA) — 1,000–2,000 mg/day combined EPA+DHA
   Function: Anti-inflammatory; supports vascular health.
   Mechanism: Resolvin production may calm neurovascular inflammation.

2. Magnesium (glycinate or citrate) — 200–400 mg elemental/day
   Function: Migraine prevention; sleep quality.
   Mechanism: NMDA receptor modulation; smooth-muscle relaxation.

3. Riboflavin (Vitamin B2) — 200–400 mg/day
   Function: Migraine prophylaxis.
   Mechanism: Mitochondrial energy support in neurons.

4. Coenzyme Q10 — 100–200 mg/day with meals
   Function: Mitochondrial support for optic nerve cells.
   Mechanism: Electron transport chain cofactor; antioxidant.

5. Alpha-lipoic acid — 300–600 mg/day
   Function: Antioxidant used in neuropathy care.
   Mechanism: Free-radical scavenging; improves nerve glucose handling.

6. Lutein + Zeaxanthin — Lutein 10 mg + Zeaxanthin 2 mg/day
   Function: Macular pigment support.
   Mechanism: Filters blue light; antioxidant action in retina.

7. Vitamin D3 — 1,000–2,000 IU/day (adjust to lab results)
   Function: Immune modulation, bone health.
   Mechanism: Nuclear receptor effects on inflammation.

8. Methylcobalamin (Vitamin B12) — 1,000 µg/day or as advised
   Function: Nerve health when deficient.
   Mechanism: Myelin synthesis and axonal metabolism.

9. Taurine — 500–1,000 mg/day
   Function: Retinal support (limited human data).
   Mechanism: Osmoregulation and photoreceptor membrane stability.

10. Curcumin (enhanced-absorption forms) — 500–1,000 mg/day
    Function: Adjunct anti-inflammatory.
    Mechanism: NF-κB pathway modulation.

Caution: Avoid high-dose vitamin A unless prescribed—excess vitamin A and related drugs can raise intracranial pressure and worsen papilledema. Review any “skin” or “supplement” products claiming vitamin A/retinoids with your doctor.

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Regenerative drugs,” and stem cell products

There are no approved immune-boosting, regenerative, or stem-cell “drugs” for PHOMS or for optic nerve shape changes. In fact, unregulated stem-cell injections have blinded patients. The U.S. FDA and the American Academy of Ophthalmology warn the public to avoid clinics selling unapproved stem-cell or exosome therapies outside properly regulated clinical trials. If someone offers to inject stem cells into or around your eye for PHOMS, do not proceed—seek a second opinion. U.S. Food and Drug AdministrationAAO

If you are interested in research, talk to your specialist about legitimate clinical trials run by universities or hospitals (they are listed on ClinicalTrials.gov). Never pay cash for “experimental” injections outside a trial.

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Surgeries or procedures

These options belong to specialist care. They target the underlying condition (especially IIH) when vision is threatened or medicines and lifestyle steps are not enough.

1. Optic Nerve Sheath Fenestration (ONSF)
   What happens: A neuro-ophthalmic surgeon makes a small window in the covering (sheath) of the optic nerve behind the eye.
   Why done: To directly relieve pressure on the optic nerve in vision-threatening papilledema (most often from IIH).
   How it helps: Creates a pathway for CSF to escape around the nerve, reducing swelling and protecting vision. JNNP

2. CSF Shunting (Lumboperitoneal or Ventriculoperitoneal Shunt)
   What happens: A thin tube diverts cerebrospinal fluid from around the spinal cord or brain into the abdomen.
   Why done: To lower intracranial pressure when medical therapy fails and vision is at risk.
   How it helps: Continuously drains CSF, decreasing papilledema. JNNP

3. Dural Venous Sinus Stenting (endovascular)
   What happens: A stent is placed in a narrowed brain venous sinus (when significant stenosis with pressure gradient is proven).
   Why done: Selected IIH patients with clear venous outflow blockage and progressive vision loss.
   How it helps: Reduces venous pressure and CSF pressure; papilledema may improve. JNNP

4. Bariatric (weight-loss) surgery
   What happens: Surgical weight-loss procedures for severe obesity.
   Why done: For some patients with difficult-to-control IIH where rapid, sustained weight loss is needed to protect vision and health.
   How it helps: Significant weight loss lowers intracranial pressure long-term, improving IIH control. American Academy of Neurology

5. Intravitreal anti-VEGF injection for peripapillary CNV
   What happens: A retina specialist injects anti-VEGF medicine into the eye in a clean room/clinic setting.
   Why done: If abnormal leaky vessels (CNV) develop near optic disc drusen and threaten vision.
   How it helps: Stops leakage and bleeding to stabilize or improve vision.

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Practical prevention habits

1. Keep a healthy weight or begin a structured program if overweight.

2. Low-sodium eating pattern most days.

3. Regular exercise that you enjoy and can sustain.

4. Screen and treat sleep apnea if you snore or are very sleepy.

5. Do not start or stop tetracyclines, isotretinoin, or high-dose vitamin A without medical advice.

6. Protect your eyes during sports and DIY activities.

7. Don’t smoke; if you do, get help to stop.

8. Keep blood pressure, glucose, and cholesterol in goal range.

9. Good sleep and headache hygiene (regular schedule, hydration, steady caffeine).

10. Keep regular eye checkups and follow the plan your doctor sets.

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When to see a doctor—right away vs soon

Go urgently (same day or ER) if you have any of these:

• Sudden vision loss in one or both eyes, or a large new blind spot.

• New, persistent double vision.

• Severe headaches, especially worse on waking, with vomiting, or with a whooshing sound in the ear (pulsatile tinnitus).

• A rapidly enlarging dark area in your vision.

Make a prompt appointment if you notice:

• Brief “graying out” of vision when standing or bending, recurring often.

• Gradually blurrier vision, new difficulty reading, or color vision changes.

• New or increasing headaches with light sensitivity.

• A family member has optic disc drusen and you have never been checked.

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What to eat and what to avoid

1. Eat: High-fiber, plant-forward meals (vegetables, fruits, beans, whole grains).

2. Eat: Lean proteins (fish, skinless poultry, legumes, tofu) to support weight goals.

3. Eat: Healthy fats (olive oil, nuts, seeds) in sensible portions.

4. Eat: Foods rich in lutein/zeaxanthin (spinach, kale, corn, eggs).

5. Eat: Omega-3 sources (fatty fish like salmon, sardines).

6. Avoid: Very salty foods (fast food, instant noodles, chips) most days.

7. Avoid: Excess added sugar (sugary drinks, sweets) that promotes weight gain.

8. Avoid: Energy drinks or heavy caffeine swings that can trigger headaches.

9. Avoid: High-dose vitamin A/retinoids unless prescribed and monitored.

10. Avoid: Smoking and heavy alcohol; both harm vascular health.

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Frequently asked questions

1) Are PHOMS a disease?
No. PHOMS are a shape change seen on OCT near the optic nerve. They are a sign that may accompany different conditions. PMC

2) Do PHOMS cause symptoms?
PHOMS themselves usually do not cause symptoms. Symptoms come from the underlying problem (for example, papilledema causing brief vision dimming or headaches).

3) Are PHOMS the same as optic disc drusen (ODD)?
No. PHOMS and ODD are different. They can occur together, but PHOMS are not drusen and not a drusen precursor. PMC

4) Can PHOMS appear in healthy children?
Yes. Large studies show PHOMS in about 1 in 11 healthy children, especially if they are near-sighted and have tilted discs. PubMed

5) Do PHOMS come and go?
They can be dynamic—appearing and later resolving in some children—another clue that they reflect changing mechanical forces, not a fixed tumor. AAO

6) What is the most important treatment if PHOMS are found with IIH?
Weight loss plus acetazolamide has the best evidence to improve papilledema and visual outcomes. PMC

7) Can PHOMS make me go blind?
PHOMS by themselves do not cause blindness, but the condition they accompany can threaten vision (for example, uncontrolled papilledema). That is why monitoring is crucial. EyeWiki

8) Do supplements shrink PHOMS?
No supplement has been proven to shrink PHOMS. Supplements can support general eye health or migraine prevention but do not replace medical care.

9) Is OCT the best test for PHOMS?
Yes. Enhanced-depth OCT around the optic nerve is the main test to see PHOMS clearly. Other tests help rule in or out the cause. PMC

10) Are there medicines that “melt” PHOMS?
No. Medicines target the cause (for example, lowering CSF pressure in IIH). There is no drug that directly removes PHOMS. JNNP

11) Do I need surgery?
Only if vision is threatened and medical/lifestyle therapy is not enough (for example, optic nerve sheath fenestration or CSF shunting in severe IIH). JNNP

12) Can I keep working or going to school?
Usually yes. Follow your treatment plan, maintain healthy habits, and attend all follow-ups.

13) Is PHOMS hereditary?
PHOMS themselves are a structural sign, not a gene disease. But optic disc drusen and myopia can run in families, so family eye checks may help. PMC

14) Are stem-cell injections safe for PHOMS?
No. There are no approved stem-cell treatments for PHOMS or for optic nerve shape changes. Unregulated injections have caused blindness. Stick to evidence-based care or legitimate clinical trials. U.S. Food and Drug AdministrationAAO

15) How often should I be checked?
Your doctor will set the schedule—often every 3–6 months at first, then less often if stable. More frequent visits are needed if you have papilledema, are starting or adjusting acetazolamide, or if your vision changes.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 21, 2025.