Good Hope Eye Clinic

Optic disc drusen & Congenitally Elevated Optic Disc 

David Kinshuck

optic disc drusen

The edge of the disc is fuzzy (ill-defined). This is explained leaflet (link)

This occurs in people born with small optic nerves, and material accumulates (the drusen) in the optic nerve. Usually vision is normal perhaps with slight loss of peripheral vision. Occasionally there is more visual field missing, and occasionally the visual fields get worse over years. See the link for details leaflet.

Disc drusen because they can be confused with other conditions, and the ophthalmologist will be able to advise other doctors, such as neurologists, who may be worried about the appearance. Also, if they do cause visual field defects (small sections of the sight missing), patients have to be checked for glaucoma.

 

Congenitally Elevated Optic Disc

  • from Jonathan D. Trobe MD Rapid Diagnosis in Ophthalmology: Neuro-Ophthalmology
  • sometimes termed pseudopapilloedema
  • Monocular or binocular congenital crowding of the optic disc indistinct margins, dome-shaped elevation, absent physiologic cup, and sometimes obvious drusen (wikipedia) Often confused with acquired optic disc elevation, especially papilledema (hence the term pseudopapilledema)
  • Visual field defects may enlarge but visual acuity remains normal

Examination

  • Indistinct optic disc margins, dome-shaped elevation, and absent physiologic cup
  • Disc vessels often have excessive tortuosity, trifurcations, or abnormal take-off
  • Optic disc drusen may be evident
  • Nerve fiber bundle visual field defects may be present they may slowly enlarge but do not impair visual acuity
  • May be difficult to distinguish from acquired optic disc oedema (especially papilledema) on ophthalmoscopic grounds alone

Ancillary Testing

  • B-scan ultrasound, or orbit CT often shows occult optic disc drusen
  • Late phase fluorescein angiography shows no dye leakage

Differential Diagnosis

  • Papilloedema
  • Diabetic papillopathy
  • Compressive optic neuropathy
  • Pre-eruptive anterior ischemic optic neuropathy

Treatment

None Retest visual fields periodically to assess whether defects are present or enlarging to the point of impairing safe driving or other visually demanding occupational tasks

Prognosis

Visual field loss may become severe (unusual) but visual acuity remains normal .