Optic Nerve Drusen

Clinical Features

• Symptoms: mostly asymptomatic, but may present with visual field defects, decreased visual acuity, or transient obscuration of vision.
• Signs:
  • Discrete, multiple, amorphous or partly calcified hyaline bodies located anterior to the lamina cribrosa
  • The bodies may be superficial or buried within the optic disc (typically in the nasal region)
  • Buried hyaline bodies in children or young people may simulate papilledema
  • Superficial drusen appear as autofluorescent bodies that are visible on fundus photographs using appropriate filter prior to fluorescein dye injection
  • As the progression of the drusen interferes with the blood supply of the optic nerve, several conditions may result:
    • Acute swelling of the optic nerve
    • Splinter hemorrhage
    • Ischemic optic neuropathy

• Fluoresecein angiography:
  • Undilated capillary network with no leakage of dye into the peripapillary region.
  • Discrete foci of hyperfluorescence with late staining of the drusen.
• B-scan ultrasound is helpful in detecting buried drusen.
• Associated ocular findings include Retinits Pigmentosa, angioid streaks in patients with or whithout pseudoxanthoma elasticum, Usher's syndrome and X-linked retinoschisis.