Optic pits are rare congenital malformations of the optic disc, characterized by a focal excavation at the optic nerve head. These pits, typically located temporally or inferotemporally, are associated with optic nerve colobomas and other congenital anomalies. While many optic pits remain asymptomatic, a significant subset leads to optic pit maculopathy (OPM), a condition marked by serous macular detachment and retinoschisis, ultimately resulting in progressive visual decline. The exact mechanism of optic pit maculopathy remains under investigation. Current hypotheses suggest that fluid originating from the vitreous cavity, cerebrospinal fluid (CSF) from the subarachnoid space, or leakage from adjacent choroidal vessels infiltrates the subretinal or intraretinal space, leading to macular detachment. Optical coherence tomography (OCT) has revealed that optic pits often create a direct communication between the vitreous and subretinal space, facilitating fluid migration. Vitreomacular traction and an anomalous posterior hyaloid interface may further exacerbate fluid accumulation. Additionally, peripapillary atrophy and the absence of a robust structural barrier at the optic disc margin contribute to fluid ingress, worsening the disease course. The treatment of optic pit maculopathy remains challenging, with no universally accepted approach. Management strategies include observation, pars plana vitrectomy (PPV) with gas tamponade (e.g., SF6 or C3F8), laser photocoagulation, and autologous tissue grafts and fibrin glue. While surgical intervention often results in anatomical improvement, visual recovery is variable, and recurrence remains a concern. Earlier intervention, before chronic photoreceptor damage occurs, may yield better functional outcomes. Advances in OCT imaging have refined disease monitoring, and future research into targeted therapeutic strategies, including regenerative approaches, may improve long-term visual outcomes.