Optic nerve head drusen: same presentation, different workup

• Author(s): Ramalho, M ; Pedrosa, C ; Santos, C ; Pina, S ; Vaz, F
• Date: 2014
• Persistent ID: http://hdl.handle.net/10400.10/1194
• Origin: Repositório do Hospital Prof. Doutor Fernando Fonseca
• Subject(s): Optic disk drusen; Pseudopapilledema
• Document Type: Conference Object
• Language: English

Description

Objective/Purpose: To report two young patients with optic nerve head drusen in wich one was interpreted initially as pappiledema. Discuss the OCT and the autofluorescence retinography optic nerve head drusen characteristics. Materials/Patients: Patient 1: A 10-year-old boy who was noted at follow-up ophthalmology consultation to have an abnormal optic nerve head. He refers a recent episode of neck pain. His past medical history is irrelevant. He has a strabismic amblyopia due to anisometropia. Fundoscopy showed bilateral disc enlargement that wasn t describe in previous consultation being interpreted as papilledema. Observation by Neuropediatry as well as the CT scan were unremarkable. Bilateral optic disc drusen were confirmed on B-scan ultrasonography, autofluorescence retinography and retinal nerve fiber layer on Stratus- OCT®. Patient 2: A 14-year-old girl went on a routine ophtalmology examination. Her past medical and ocular history were irrelevant. On examination visual acuity was 10/10 in both eyes. Fundoscopy showed bilateral disc enlargement being interpreted as optic nerve head drusen. Bilateral optic nerve head drusen were confirmed on B-scan ultrasonography, autofluorescence retinography and retinal nerve fiber layer on Stratus-OCT®. Methods: B-scan ultrasonography, autofluorescence retinography and Stratus-OCT imaging were obtained. Results and Conclusion Both patients were assymptomatic. With non-invasive readily available exams, such as ultrasonography and OCT practioners must rule out optic nerve head before costly and invasive exams , even when there is a history and fundoscopy highly suggestible of papilledema. Optic nerve head drusen were first described in 1868 by Liebreich. They are mostly bilateral and assymptomatic, although some degree of visual field defect can be shown. Most cases of pseudopapilledema are due to the presence of optic nerve head drusen, there are some clinical characteristics that can help to differenciate one from another but the use of recent technology is needed to confirm the diagnosis.