Clinical appearance of optic disc drusen in childhood

Abstract

In a series of 50 individuals with optic disc drusen diagnosed before the age of 15, the anomaly occurred most often in the form of an elevation of the whole or one part of the optic disc without visible superficial drusen. Superficial drusen were seen only in 15 of the 92 eyes with the anomaly. In those 42 subjects in whom the anomaly was bilateral, it was seldom symmetrical. The reduced visual acuity found in a few cases could be attributed to causes other than the drusen. In 10 eyes the anomaly was observed to be associated with visual field defects. The age distributions of the subjects with visual field defects and with superficial drusen show that they were more common among older children. The superficial position of the drusen and the presence of visual field defects do not, however, have a close cause-and-effect relationship. A cilioretinal artery was observed to co-exist with optic disc drusen with a high frequency, i.e. in more than 40 per cent. Other vascular aberrations were also noted in association with the optic disc anomaly. Neurological symptoms were the most common cause for consultation in the 50 children examined. In more than half of the present cases appearance of the optic disc had contributed to the suspicion of an intracranial expansive process. A fallacious similarity between the elevation of the optic disc caused by buried drusen and optic disc edema caused by increased intracranial pressure presents a problem of differential diagnosis, expressly in younger children.