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Although optic disc cupping is mostly seen in glaucoma patients, it can occur in non-glaucomatous
optic neuropathies (NGON). The characteristics of NGON are cupping toxic optic neuropathies,
optic neuritis, compressive ischemia, and hereditary nature. The basic components of optic disc
cupping are prelaminar and laminar. Prelaminar thinning, which seemed to be non-specific, occurs
in all types of retinal ganglion cell axon loss; such as compressive, ischemic, and inflammatory
events; glaucoma; and aging. This form of cupping is usually shallow, with less excavation
of the optic disc. Laminar type of cupping which is a clinically profound type of cupping, may
damage peripapillary scleral and lamina cribrosa. Sometimes experienced clinicians cannot
clearly distinguish glaucomatous from non-glaucomatous cupping. The non-glaucomatous optic
neuropathy has more neuroretinal rim pallor with less excavation of the disc than in glaucoma.
It also involves central visual acuity and color vision in primary levels with visual field defects
aligned vertically and respecting the midline. Evaluation of the patient’s medical records, disease
presentation, ocular function, and examination are also crucial. Secondary examinations, including
visual field examination and optical coherence tomography (OCT) or neuroimaging, facilitate the
disease’s differentiation. This review presents the methods of examining a patient with an increased
cup-to-disc ratio.

Keywords: Low tension glaucoma, Pallor, Optic nerve diseases, Glaucoma, Neuritis

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