Optic nerve drusen and pseudopapilledema
Gutteridge, I.F.
American Journal of Optometry and Physiological Optics 58(8): 671-676
1981
ISSN/ISBN: 0093-7002 PMID: 6169281 Document Number: 386725
The reported incidence of visible optic nerve drusen range from 3.4/1000-20.4/1000 in the general population, the discrepancy suggesting that many drusen are buried or are too small to be visible clinically. Drusen of the optic nerve head are an important consideration in the differential diagnosis of papilledema, papillitis, and pseudopapilledema. This case report describes a 22-year old white female patient with previously undetectedoptic nerve head drusen. She presented on June 20, 1979 for optometric examination with symptoms and signs suggestive of increased intracranial pressure or optic neuritis, namely reduced visual acuity, recent onset of severe headaches, central visual field loss, and an elevated right optic disc. The patient reported that her general health was good and she was not under any medical treatment; she was taking oral contraceptives for several years with no apparent side effects. Opthalmological examination and fluorescein angiography confirmed the appearance of both optic discs and the drusen in the right optic disc. Optic nerve drusen can cause visual field losses, but reduction in visual acuity is a rare finding. The pills were discontinued as a precaution. Neurological examination revealed no orbital, cranial, or ventricular abnormalities. The neurologist diagnosed muscle contraction (tension headache) and a tricyclic antidepressant was prescribed. In August 1980, visual acuities were unchanged but there was a reduction in the frequency and intensity of the headaches. This case associates unilateral visible optic nerve and head drusen and a contralateral visual acuity loss with moderate hypermetropia and pill use. Complication of pill use, such as venous thrombosis associated with papilledema was a possible diagnosis. However, there were several indications that the right optic disc elevation was in fact congenital anomalous elevation (pseudopapilledema) with drusen. The important point to remember is that anomalous elevation of disc with drusen and hypermetropia must not only be differentiated from papilldema and optic neuritis, but may also occur in association with these conditions.