Drusen Optic Neuropathy

    • Optic neuropathy associated with optic disc-embedded hyaline bodies called “drusen,” which are mitochondria ejected from damaged axons
    • May be caused by crowding in a narrow scleral canal
    • Often misdiagnosed as papilledema
    • Glistening nuggets that protrude from the optic disc or are buried beneath its surface
    • Buried drusen may be revealed by
      • Autofluorescence fundus photography
      • B-scan ultrasound
      • Optical coherence tomography
      • Orbit CT
    • Nerve fiber bundle visual field defects, sparing the maculopapillar bundle, reflect loss of axons
    • Papilledema
    • Papillitis
    • Ischemic optic neuropathy
    • Diabetic papillopathy
    • Leber hereditary optic neuropathy
    • Look for drusen with ophthalmoscopy or ancillary studies
    • Order brain MRI if there are nerve fiber bundle visual field defects because you cannot presume that drusen optic neuropathy is the whole explanation
    • Patients with drusen may develop slowly progressive visual field defects that do not affect visual acuity but may eventually compromise safe driving, therefore…
    • Tip: patients should undergo serial visual field testing to exclude the development of defects that would make driving unsafe
    • Patients may develop sudden vision loss from peripapillary subretinal hemorrhage
    • Advise patients that future examiners performing ophthalmoscopy may misdiagnose papilledema and initiate unnecessary evaluations

    Optic Nerve And Chiasm Disorders

    Drusen Optic Neuropathy Colobomatous Optic Neuropathy Optic Pit Neuropathy Morning Glory Optic Neuropathy Hypoplastic Optic Neuropathy Typical Optic Neuritis Atypical Optic Neuritis Papillitis (Neuroretinitis) Non-arteritic Ischemic Optic Neuropathy Arteritic Ischemic Optic Neuropathy Posterior Ischemic Optic Neuropathy Hypotensive Ischemic Optic Neuropathy Radiation-induced Optic Neuropathy Diabetic Papillopathy Hypertensive Optic Disc Edema Papilledema Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Compressive Optic Neuropathy: Overview Optic Neuropathy of Graves Disease Optic Nerve Sheath Meningioma Sphenoid Meningioma Craniopharyngioma Pituitary Adenoma Pilocytic Astrocytoma (Optic Glioma) Carotid Aneurysm Suprasellar Germinoma Infiltrative (Neoplastic) Optic Neuropathy Paraneoplastic Optic Neuropathy Traumatic Optic Neuropathy Toxic Optic Neuropathy Nutritional Deficiency Optic Neuropathy Dominantly-Inherited Optic Neuropathy Leber Hereditary Optic Neuropathy Primary Open Angle Glaucoma