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Case Reports
. 2018 Sep 19;43(5):330-333.
doi: 10.1080/01658107.2018.1520900. eCollection 2019 Nov.

Acute Unilateral Anterior Ischemic Optic Neuropathy Secondary to Optic Nerve Head Drusen: Report of a Rare Coexistence

Omer Karti  1 , Dilek Top Karti  2 , Mehmet Ozgur Zengin  1 , Bora Yüksel  1 , Mustafa Oguztoreli  1 , Tuncay Kusbeci  1
Affiliations
Case Reports

Acute Unilateral Anterior Ischemic Optic Neuropathy Secondary to Optic Nerve Head Drusen: Report of a Rare Coexistence

Omer Karti et al. Neuroophthalmology. .

Abstract

A 45-year-old white male noticed on awakening the painless loss of inferior vision in the left eye 2 days ago. He was otherwise well and his medical history was unremarkable. Visual acuity was 20/20 in OD and 20/32 in OS with a left inferior altitudinal defect and right blind spot enlargement demonstrable on visual field test. On fundus examination, both disc margins were blurred and the left disc was diffusely oedematous, with linear haemorrhages in the adjacent nerve fibre layer. Radiologic imaging and laboratory tests were unremarkable. Bilateral optic nerve head drusen (ONHD) was demonstrated by optical coherence tomography and fundus autofluorescence imaging. Unilateral acute non-arteritic anterior ischemic optic neuropathy (NAION) and concomitant bilateral ONHD were diagnosed. NAION may develop secondary to ONHD. Therefore, clinicians should be aware of this rare association and inform the patients about this risk. Patients with ONHD should be followed-up periodically in terms of possible ischemic complications.

Keywords: Fundus autofluorescence; ischemic optic neuropathy; optic nerve head drusen; optical coherence tomography.

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Figures

Figure 1.
Figure 1.
Fundus picture, fundus autofluorescence (FAF) image and spectral-domain optical coherence tomography (SD-OCT) findings of optic nerve head drusen (ONHD). Fundus picture showing bilateral blurred optic disc margins with left disc oedema with splinter hemorrhages in adjacent nerve fibre layer (green arrow) and ONHD appearance in the nasal side of the right disc and inferior side of the left disc (blue arrows) (A). FAF image showing “hyperautofluorescence” appearance in the nasal side of the right disc and inferior side of the left disc (yellow arrows) (B). SD-OCT image showing a “lumpy-bumpy” internal contour appearance at the optic disc in both eyes (red contours) (C).
Figure 2.
Figure 2.
Visual field showing blind spot enlargement in the right eye (A) and inferior altitudinal defect in the left eye (B).
Figure 3.
Figure 3.
Computed tomography scan of optic nerve head showing calcification of the optic disc in both eyes (red arrows).
See this image and copyright information in PMC

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