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Optic disc drusen


Key points

  • Definition: Optic disc drusen (ODD) are tiny yellow or white globules of hyaline-like material deposited on or below the surface of the optic disc, which progressively calcify producing visual field defects.

  • Also known as optic nerve head drusen (ONHD), disc hyaline bodies, pseudopapilledema, pseudoneuritis, buried disc drusen, and congenitally elevated or anomalous discs.

  • Classic clue: Small sharply circumscribed dense calcification at one or more optic discs, truly an orbital “Aunt Minnie.”

  • One is a “druse,” but they usually hang out in packs of drusen.

  • Over time, micro-drusen (<25 µm) coalesce, forming larger deposits that mineralize, becoming visible on computed tomography (CT). ,

  • Probable remnants of an axonal transport system of degenerated retinal ganglion cells.

  • Fewer than 50% of drusen demonstrated by imaging are seen on ophthalmoscopic exam.

Imaging

  • ODDs vary from less than 1 mm to 4 mm in diameter and 3 mm in thickness.

Computed tomography features

  • Childhood drusen are small and nonmineralized.

  • May see slight swelling and increased attenuation on CT.

  • Adult drusen demonstrate well-defined calcifications a few millimeters in size.

  • ODDs are (by definition) co-located with the optic disc.

  • Occasionally drusen may be away from the optic disc (see “Differential Diagnosis” later).

Magnetic resonance imaging features

  • T2 weighted image (WI) demonstrates ODD as posterior chamber “filling defect” co-located with the optic disc.

  • T1 Gd shows no associated enhancement as may be found with melanoma.

Clinical issues

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