Abstract Nanophthalmos is an uncommon developmental ocular disorder characterized by a small eye with short axial length, high hyperopia and high lens/eye volume ratio due to arrested development of the globe in all directions. Different types of fundus changes can rarely occur with nanophthalmos. We describe five cases of nanophthalmos, each of them presenting with a different fundus appearance. Our case series highlights variability of pigmentary changes from retinal flecks to bone spicules and bull's eye maculopathy, which are rare in the combinations described here. Introduction Nanophthalmos is a rare, bilateral disorder consequent upon the arrest of development of the globe in all dimensions. 1 This occurs after the foetal fissure has closed and without other major malformations. It is characterized by short axial lengths, usually less than 20.00mm, and extreme hyperopia with refractive error usually in the range of +8.00 to +25.00 dioptres (DS). Characteristic features include normal cornea to microcornea, shallow anterior chamber and high lens/globe ratio. There is a considerably thickened choroidal vascular bed and scleral coat. 2 Abnormal scleral collagen has been found to be a cause of uveal effusion in patients with nanophthalmos. 3 The best corrected visual acuity is rarely better than 20/40. Patients with nanophthalmos in the present study had cycloplegic refraction, best corrected visual acuity assessments using ETDRS and Lea charts, slit-lamp and fundus examinations, intraocular pressure measurement, fundus photography and ultrasonographic examination using A-mode and B-mode. Electrodiagnostic tests were not carried out. We describe five 791 J Pak Med Assoc Case Series Variable retinal presentations in nanophthalmos Ayesha Khan, Saemah Nuzhat Zafar Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi, Pakistan.