Distinguishing optic disc drusen from papilloedema

Abstract

Consider optic disc drusen in optic disc swelling to ensure appropriate investigations and management

Drusen and the misleading optic disc

“…The presence of spontaneous venous pulsation, best detected using a direct ophthalmoscope, also makes the diagnosis of papilloedema unlikely. Confusingly, peripapillary haemorrhage, as seen in figure 1C, can occur with drusen and papilloedema 3…”

“…However, drusen are usually buried in childhood and rarely become superficial before the age of 12 years (figure 1C). 3 This makes them more difficult to diagnose and more likely to be mistaken for papilloedema 3. However, a careful and detailed fundoscopic examination reveals significant differences 3.…”

“…3 This makes them more difficult to diagnose and more likely to be mistaken for papilloedema 3. However, a careful and detailed fundoscopic examination reveals significant differences 3. True papilloedema is associated with disc hyperaemia and swelling of the peripapillary retina that obscures the retinal vasculature at the disc margin (figure 1D).…”

“…True papilloedema is associated with disc hyperaemia and swelling of the peripapillary retina that obscures the retinal vasculature at the disc margin (figure 1D). 3 Venous congestion, exudates and cotton wool spots can sometimes be seen in papilloedema but never with drusen. Furthermore, drusen are often associated with anomalous retinal vascular patterns (figure 3), including an increased number of vessels, abnormal early branching and a higher frequency of cilioretinal arteries 1.…”

“…They have a prevalence of 0.3–2.4% and are bilateral in 75% of cases 1. Despite being mostly asymptomatic, they are the most frequent cause of confusion between true papilloedema and pseudopapilloedema 3. Obviously, therefore, clinical suspicion of drusen is important in patients with oedematous looking discs in order to avoid unnecessary investigations and anxiety.…”