This 29yo male presented with asymptomatic bilateral optic nerve drusen. Vision was 20/40 OD and 20/30 OS.
The drusen hyperautofluoresce, and visual fields show some non-specific depression and defects.
Learning Points:
Optic disc drusen are small hyaline bodies within the optic nerve that progressively calcify over time. They can be buried or superficial, giving the nerve a “lumpy-bumpy” appearance with normal overlying vessels. These nerves can often be confused with papilledema, especially in younger patients.
We have found ultrasonography to be totally unhelpful in younger patients, since drusen don’t calcify until later in life.
The drusen often hyperautofluoresce on fundus autofluorescence imaging. Swept-source OCT can occasionally visualize buried drusen, which can be either hypo- or hyperreflective.
When autofluorescence is negative, the best clinical test is fluorescein angiography, which will show optic nerve leakage with papilledema. Eyes with drusen will show either no nerve leakage or nodular staining.
