Practice Lesson of the Week

Distinguishing optic disc drusen from papilloedema

BMJ 2008; 337 doi: (Published 10 November 2008) Cite this as: BMJ 2008;337:a2360
  1. Kuang Hu, specialty registrar,
  2. Alison Davis, consultant,
  3. Eoin O’Sullivan, consultant
  1. 1Department of Ophthalmology, Mayday University Hospital, Croydon CR7 7YE
  1. Correspondence to: K Hu kuanghu{at}
  • Accepted 7 July 2008

Consider optic disc drusen in optic disc swelling to ensure appropriate investigations and management

We report a patient with optic disc drusen, a common anomaly that may mimic papilloedema (swelling of the optic discs as a result of raised intracranial pressure). We suggest that optic disc drusen (globular collections of calcific material in the optic nerve head1) should be considered routinely in the differential diagnosis of bilateral optic disc swelling. Although optic disc drusen may coexist with papilloedema,2 awareness of the former will help to direct appropriate investigations and management.

Case report

A 6 year old girl was referred urgently to our ophthalmology department with a one month history of headache and the finding of swollen optic discs in both eyes. The referring optometrist was concerned that the patient might have papilloedema.

The patient reported that her headache was intermittent, frontal, and associated with nausea. She denied vomiting or visual problems, including transient visual obscurations (sudden blanking of vision lasting seconds) and double vision. Apart from wearing glasses with a small hyperopic prescription, she had no previous ophthalmic or medical history of note. She was not taking any medication.

On examination, her pupils were dilated after pharmacological dilatation by the referring optometrist. Consistent with the expected effect of pupillary dilatation, the visual acuity with glasses was 6/9 in each eye. She had no visual field defect to confrontation, and colour vision was normal. Ocular movements were full, and the rest of the cranial nerve examination was unremarkable. Funduscopy showed swollen optic discs in both eyes, with anomalous branching of the retinal vasculature (fig 1). We started investigations to determine whether optic disc drusen were present. …

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