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Journal of Postgraduate Medicine, Vol. 49, No. 3, July-Sept, 2003, pp. 276-277 Images in Medicine Optic Disc Drusen Dhingra N, Prasad S
Department of Ophthalmology, Arrowe Park Hospital,
Upton, Wirral CH49 5PE UK. Code Number: jp03074 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
Copyright 2003 - Journal of Postgraduate Medicine. Online full-text also available at http://www.jpgmonline.com/ The following images related to this document are available:Photo images[jp03074f1.jpg] [jp03074f2.jpg] [jp03074f3.jpg] |
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