Optic Nerve Drusen

Bilateral, symmetrical superficial optic nerve drusen demonstrating autofluorescence. Bilateral, symmetrical superficial optic nerve drusen demonstrating autofluorescence.

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.