Optic disc drusen.
Image credit: Courtesy of Andre Marques, M.D. American Academy of Ophthalmology. Used with permission for educational purposes.
Optic Disc Drusen
Optic disc drusen.
Image credit: Courtesy of Rod Foroozan, M.D. American Academy of Ophthalmology. Used with permission for education purposes.
Optic Disc Drusen
Optic disc drusen.
Image credit: Courtesy of Mansi Parikh, M.D. American Academy of Ophthalmology. Used with permission for educational purposes.
Optic Disc Drusen
Buried optic disc drusen.
A. Left optic disc demonstrating fullness but no obvious drusen.
B. B-scan ultrasonography of patient’s left eye reveals hyperechoic, high signal characteristic of optic disc drusen (see arrow).
Image credit: American Academy of Ophthalmology. Used with permission for educational purposes.
Optic Disc Drusen
Optic disc drusen.
Optic disc drusen are hyaline or calcified deposits within the optic nerve head. They may be visible at the optic nerve head or buried. Nasal visual field defects and other glaucoma-like visual field defects may be present, though most visual field defects are asymptomatic.
There are many imaging modalities that help visualize optic nerve drusen, including B-scan ultrasonography (C), autofluorescence (D), and CT (E).
A. Fundus photograph of optic disc drusen, showing blurred disc margin with scalloped edge, refractile bodies on the disc surface and at the superior pole, mild pallor, and no obscuration of retinal blood vessels.
B. Visual field patterns confirmed the presence of a nasal step produced by drusen involving the right disc.
C. B-scan ultrasonogram, demonstrating focal, highly reflective (due to calcification) elevation within the optic disc (arrow), which persists when the gain is decreased
D. Preinjection fundus photograph demonstrating autofluorescence (arrow).
E. CT scan of the orbits. Calcified optic disc drusen are visible bilaterally at the posterior globe–optic nerve junction (arrows).
Part A courtesy of Steven A. Newman, MD; part B courtesy of Michael S. Lee, MD; parts C, E courtesy of Anthony C. Arnold, MD; part D courtesy of Hal Shaw, MD.
Image credit: Basic and Clinical Science Course, Section 5: Neuro-Ophthalmology. San Francisco: American Academy of Ophthalmology, 2018-2019: 142. Used with permission for educational purposes.
Optic Disc Drusen
Optic disc drusen.
Optic disc drusen are hyaline and calcified nodules within the optic nerve head. They may be visible on the surface of the optic nerve or buried, mimicking optic nerve edema (pseudoedema). Drusen may autofluoresce, which may help reveal optic disc drusen.
Image credit: American Academy of Ophthalmology. Used with permission for educational purposes.
Papilledema with Pseudopapilledema Features
Papilledema with pseudopapilledema features.
Papilledema is optic nerve edema secondary to increased intracranial pressure. The optic nerves are hyperemic, with whitish opacification of the peripapillary retinal nerve fiber layer. Telangiectatic vessels are seen on the temporal optic disc in the left eye. In severe cases of papilledema the retinal vasculature will become obscured by the nerve fiber layer edema.
In this case, the appearance of the optic nerve is confounded by yellowish refractile bodies on the nasal aspect of both optic nerves and the anomalous branching appearance of the retinal vessels in the left optic nerve. There is some nerve fiber layer whitening most pronounced in the superior aspect of the right optic nerve, and the retinal vessels are not obscured.
Differentiating papilledema from pseudopapilledema is extremely difficult based on clinical appearance alone. The presence of pseudopapilledema does not exclude papilledema. Ancillary testing that may help differentiate between papilledema and pseudopapilledema include OCT, autofluorescence, fluorescein angiography, and ultrasound. In cases where the diagnosis remains in doubt clinically, the patient should be counseled regarding whether to proceed with further workup for intracranial hypertension (MRI/MRV brain, LP with opening pressure, CSF studies) or to observe. This is often guided by the patient’s symptoms and the clinical suspicion for increased intracranial pressure.
Image credit: American Academy of Ophthalmology. Used with permission for educational purposes.