Pathological optic disc cupping is most often caused by open angle glaucoma. More rarely, other optic neuropathies may be associated with acquired pathological optic disc cupping, sometimes mimicking glaucoma. A careful interpretation of the history, optic disc characteristics and visual fields are the main tools in the decision process of glaucomatous versus non-glaucomatous optic disc cupping, avoiding inappropriate, expensive neuroimaging examinations.