Neuro-Ophthalmology

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Optic Nerve
Bilateral superficial optic nerve drusen

  • Clinical features:
    • Symptoms: mostly asymptomatic, but may present with visual field defects, decreased visual acuity, or transient obscuration of vision.
    • Signs:
      • Discrete, multiple, amorphous or partly calcified hyaline bodies located anterior to the lamina cribrosa
      • The bodies may be superficial or buried within the optic disc (typically in the nasal region)
      • Buried hyaline bodies in children or young people may simulate papilledema
      • Superficial drusen appear as autofluorescent bodies that are visible on fundus photographs using appropriate filter prior to fluorescein dye injection
      • As the progression of the drusen interferes with the blood supply of the optic nerve, several conditions may result:
        • Acute swelling of the optic nerve
        • Splinter hemorrhage
        • Ischemic optic neuropathy
  • Fluoresecein angiography:
    • Undilated capillary network with no leakage of dye into the peripapillary region.
    • Discrete foci of hyperfluorescence with late staining of the drusen.
  • B-scan ultrasound is helpful in detecting buried drusen.
  • Associated ocular findings include Retinits Pigmentosa, angioid streaks in patients with or whithout pseudoxanthoma elasticum, Usher's syndrome and X-linked retinoschisis.

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