Journal of Postgraduate Medicine
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Year : 2003  |  Volume : 49  |  Issue : 3  |  Page : 276-277  

Optic Disc Drusen

N Dhingra, S Prasad 
 Department of Ophthalmology, Arrowe Park Hospital, Upton, Wirral CH49 5PE, United Kindom

Correspondence Address:
N Dhingra
26, Bron-Y-Nant, Croesnewydd Road, Wrexham LL13 7TX.
United Kindom




How to cite this article:
Dhingra N, Prasad S. Optic Disc Drusen .J Postgrad Med 2003;49:276-277


How to cite this URL:
Dhingra N, Prasad S. Optic Disc Drusen . J Postgrad Med [serial online] 2003 [cited 2020 May 27 ];49:276-277
Available from: http://www.jpgmonline.com/text.asp?2003/49/3/276/1149


Full Text

A 54-year-old patient was found to have raised bilateral optic nerve heads along with haemorrhage on his right optic disc on routine screening for diabetic retinopathy, by his optician. He was referred to the eye clinic. On examination at the eye clinic, his visual acuity in both eyes was 6/6 with equally reacting pupils. Fundoscopy revealed healthy pink discs with a lumpy appearance along with premature branching of the vessels as they emerged from the discs [Figure:1] and [Figure:2]. No disc haemorrhage was seen and the visual fields showed an enlarged blind spot. An ocular ultrasound confirmed the presence of an elevated lesion in front of the optic nerve head with high reflectivity [Figure:3]. Bilateral optic disc drusen was diagnosed and the patient was reassured and discharged.



  

   Discussion



Optic disc drusen are condensations of hyaline-like material within the substance of the optic nerve head.[1] Clinically they are seen in 0.3% of the population and are often bilateral. In early childhood they may be difficult to detect because of the deep location within the optic nerve head and may mimic papilloedema. The lumpy appearance of the disc, presence of spontaneous venous pulsations and anomalous vascular pattern help to differentiate it from the latter. In doubtful cases, a simple ocular ultrasound can easily demonstrate its presence.[2] By adulthood they usually appear at the surface and can be easily seen with a direct ophthalmoscope.

The retinal vessels of eyes with optic disc drusen present with pronounced tortuosity and dilatation of the veins and abnormal early branching with trifurcation. Optic disc drusen can be associated with variable field defects and peripapillary haemorrhages, which resolve spontaneously. The incidence of retinal haemorrhage in optic disc drusen is reported to be 2-10% .[3],[4] In most cases the retinal haemorrhages are incidental findings without impairment of visual acuity. In this case, the retinal haemorrhage detected by the optician had resolved by the time the patient was seen in the eye clinic. No significant connection has been found between optic disc drusen and systemic disorders except for pseudoxanthoma elasticum. The incidence of pseudoxanthoma elasticum in two series with optic disc drusen has been reported as 1.4% to 3.6%.[5]

This case highlights the importance of diagnosing this relatively benign ocular cause of pseudopapilloedema. Remembering the clinical features of this condition and by simple direct ophthalmoscopy, non-ophthalmologists can avoid their patients being subjected to unnecessary neuroimaging procedures.

References

1Kanski JJ. Optic disc drusen In: Clinical Ophthalmology. 4th edn. Oxford: Butterworth Heinemann; 1999. pp 602.
2Kurz-Levin MM, Landau K. A comparison of imaging techniques for diagnosing drusen of the optic nerve head. Arch Ophthalmol 1999;117:1045-9.
3Mustonen E. Pseudopapilloedema with and without verified optic disc drusen. A clinical analysis I. Acta Ophthalmol (Copenh) 1983;61:1037-56.
4Rubinstein K, Ali M. Retinal complications of optic disc drusen. Br J Ophthalmol 1982;66:83-95.
5Lorentzen SE. Drusens of the optic disc. A clinical and genetic study. Acta Ophthalmol (Copenh) 1966;90:1-180.

 
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