Drusen of the Optic Nerve

Abstract

It is not unusual to see patients evaluated for papilledema when in fact they have optic nerve drusen. Three patients in 1000 demonstrate drusen of the optic nerve. In familial cases, the inheritance is autosomal dominant. These patients may be asymptomatic or may note a decrease in visual acuity (25%). Visual field defects are seen in 25% of the patients. Drusen are rare in oriental or black persons. Clinical evaluation may demonstrate an irregular nerve head with multiple excrescences on the surface. Because many cases have the drusen deep within the nerve, blurring of the margins of the disc may be all that is present. At times, the drusen grow; and if they are located adjacent to a vessel, optic atrophy, optic nerve hemorrhage, juxta-papillary subretinal hemorrhages, or an infarct may ensue. In cases where one suspects buried drusen, computed tomography and B-scan ultrasonography may be helpful.