06/03/2026
Optic disc drusen.
The value of high resolution multimodal imaging.
Typically asymptomatic, and most frequently diagnosed on routine eye testing as anomalous optic disc appearance or “pseudo papilloedema”. In children, the optic disc appearance can raise concern for potential raised intracranial pressure from serious pathology (like a brain tumour).
In disc drusen there is elevation and lumpy appearance to the optic discs, but no true swelling (no haemorrhage, no retinal vascular dilation and tortuosity, no retinal nerve fibre layer oedema (see the ILM reflex hugging the disc margin in these photos)).
If drusen are exposed they exhibit hyper-autofluorescence, and may be visualised on the OCT.
In infants, drusen may be buried within the optic disc. In all cases, ultrasound can be used to diagnose the drusen as highly hyperechoic deposits. The best way to perform ultrasound in infant eyes is to use a linear ultrasound with the gain reduced and avoiding the crystalline lens (as shown here, using the technique described by ). The deposit in the left eye is larger than the right, consistent with what is seen on the other imaging modalities
In the asymptomatic child, unnecessary invasive testing (MRI and lumbar puncture under general anaesthesia), can be avoided through careful clinical examination and multimodal imaging.
Optic disc drusen affect 1% of the population and are dominantly inherited, so examining the parents’ optic discs may be helpful.
