CASE REPORT
A 15-year-old child presented with a headache for a few months. His visual acuity came out as 6/6 in both eyes.
Dilated Fundoscopy revealed elevated discs and blurring of the margins in both eyes. B scan was done to confirm the diagnosis of optic disc drusens.
OCT confirmed the thinning of the retinal nerve fiber layer and elevation of the optic disc along with blurry and irregular margins. FAF showed hyper autofluorescence of both discs.
Optic disc drusens entity
Optic disc drusens are progressive, usually bilateral, and asymptomatic types of optic neuropathy in which benign and acellular deposits appear at the optic disc thus making the disc elevated and its margins blurry.
These drusens are mostly mucoproteins or mucopolysaccharides which are Remnants of degenerated retinal ganglion cells. The exact cause of optic disc drusens is not known but is predicted to be due to the abnormal flow of materials in optic nerve cells. There may be a family history of ODD but can also be non-inherited.
These drusens can be classified as buried or superficial. Buried drusen are uncalcified and not seen at the optic nerve head, but the optic disc is elevated with blurry margins due to which they can be misdiagnosed with another term called papilloedema which refers to swelling of the optic disc along with blurring of its margins due to increased intracranial pressure.
Due to their buried nature, it is a challenging task for an ophthalmologist to differentiate between papilloedema and ODD. These are mostly present in children. Superficial drusens are clearly visible at the optic nerve head.
With age optic nerve drusens get calcified and larger, thus compressing normal nerve structures ultimately resulting in visual field defects and vision loss.
MANAGEMENT of Optic disc drusens
No treatment is available to reverse the visual loss caused by optic disc drusens, although IOP-lowering drugs can be given in patients who have borderline IOP and marked visual field defects.
Complication
They have an increased risk of anterior ischemic optic neuropathy (AION).
Prognosis
ODD is a self-limiting disease and has a good prognosis.
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REFERENCES
- Thompson AC, Bhatti MT, El-Dairi MA. Bruch’s membrane opening on optical coherence tomography in pediatric papilledema and pseudopapilledema. J AAPOS. 2018;22:38–43.
- Tuğcu B, Özdemir H. Imaging Methods in the Diagnosis of Optic Disc Drusen. Turk J Ophthalmol. 2016;46:232–236.
- Thurtell MJ, Biousse V, Bruce BB, Newman NJ. Optic nerve head drusen in black patients. J Neuroophthalmol. 2012;32:13–16.
- Auw-Haedrich C, Staubach F, Witschel H. Optic disk drusen. Surv Ophthalmol. 2002;47:515–532.
- Lam BL, Morais CG Jr, Pasol J. Drusen of the optic disc. Curr Neurol Neurosci Rep. 2008;8:404–408.
