Optic disc drusen

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Optic disc drusen
Other namesOptic nerve head drusen
Bilateral optic disc drusen in computed tomography seen as dense spots at the optical disc
SpecialtyNeurology Edit this on Wikidata

Optic disc drusen (ODD) are globules of

retinal ganglion cells.[3][4][5]
ODD have also been referred to as congenitally elevated or anomalous discs, pseudopapilledema, pseudoneuritis, buried disc drusen, and disc hyaline bodies.[6]

Anatomy

The

ophthalmoscope. It is located nasally and slightly inferior to the macula of the eye. There is a blind spot at the optic disc because there are no rods or cones beneath it to detect light. The central retinal artery and vein can be seen in the middle of the disc as it exits the scleral canal
with the optic nerve to supply the retina. The vessels send branches out in all directions to supply the retina.

Pathophysiology

In children, optic disc drusen are usually buried and undetectable by fundoscopy except for a mild or moderate elevation of the optic disc. With age, the overlying axons become atrophied and the drusen become exposed and more visible. They may become apparent with an

vitreous hemorrhage may develop.[8]

Diagnosis

Differential diagnosis

In most patients, optic disc drusen are an incidental finding. It is important to differentiate them from other conditions that present with optic disc elevation, especially

Leber Hereditary Optic Neuropathy and linear nevus sebaceous syndrome.[11]

Management

Patients with optic disc drusen should be monitored periodically via

nerve fiber layer thickness.[12] Associated conditions such as angioid streaks and retinitis pigmentosa should be screened for. Both the severity of optic disc drusen and the degree of intraocular pressure elevation have been associated with visual field loss.[13][14] There is no widely accepted treatment for ODD, although some clinicians will prescribe eye drops designed to decrease the intra-ocular pressure and theoretically relieve mechanical stress on fibers of the optic disc. Rarely choroidal neovascular membranes may develop adjacent to the optic disc threatening bleeding and retinal scarring. Laser treatment[15][16] or photodynamic therapy[17] or other evolving therapies[18]
may prevent this complication.

Prognosis

Optic nerve damage is progressive and insidious. Some of patients will develop some peripheral field defects. These can include nasal step defects, enlarged blind spots, arcuate scotomas, sectoral field loss and altitudinal defects.[6] Clinical symptoms correlate to visibility of the drusen.[13] Central vision loss is a rare complication of bleeding from peripapillar choroidal neovascular membranes. Anterior ischemic optic neuropathy (AION) is a potential complication.[19][20]

Epidemiology

Optic disc drusen are found clinically in about 1% of the population but this increases to 3.4% in individuals with a family history of ODD. About two thirds to three quarters of clinical cases are bilateral.

Bruch membrane drusen of the retina which have been associated with age-related macular degeneration.[6]

See also

References

  1. ^ a b c Golnik, K. (2006). Congenital anomalies and acquired abnormalities of the optic nerve, (Version 14.3). UptoDate (On-Line Serial)
  2. ^
    PMID 1064209
    .
  3. PMID 16358654
    .
  4. PMID 7335311
    .
  5. S2CID 21285492
    .
  6. ^ a b c d e f "Optic Nerve Head Drusen". Handbook of Ocular Disease Management. Jobson Publishing L.L.C. 2001. Archived from the original on 2004-12-09.
  7. PMID 15662245
    .
  8. ISBN 978-0-07-140235-4
    .
  9. ISBN 978-0-7817-4811-7
    .
  10. ^ Online Mendelian Inheritance in Man (OMIM): Kenny-Caffey Syndrome type 2 - 127000
  11. ^ Online Mendelian Inheritance in Man (OMIM): Schimmelpenning-Feuerstein-MIMS Syndrome - 163200
  12. PMID 16752318
    .
  13. ^
    S2CID 23851816
    .
  14. S2CID 801305
    .
  15. PMID 15043550
    .
  16. PMID 26493180
    .
  17. PMID 15688974
    .
  18. S2CID 9963072
    .
  19. PMID 14718294
    .
  20. S2CID 239031007
    .
  21. PMID 10406605
    .
  22. ISBN 978-0-07-137831-4
    .
  23. ^ Online Mendelian Inheritance in Man (OMIM): Noonan syndrome - 163950
  24. PMID 9022108
    .

Further reading

External links

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