Optic Disc Drusen

Optic disc drusen (ODD) are abnormal deposits of protein and calcium within the optic nerve head. They can make the optic disc appear elevated, mimicking papilledema, but they're usually a benign finding.

What Are They

• Calcified hyaline deposits
• Within substance of optic nerve head
• Build up over years
• May become visible (surface) or remain buried
• Often bilateral

Symptoms

Often None

• Many discovered incidentally
• Routine eye exam finding

When Present

• Visual field deficits—peripheral loss
• Rarely central vision affected
• Rarely: transient visual obscurations
• Very rarely: sudden vision loss (from vascular event)

Why They Matter

Pseudo-papilledema

• Elevated discs can look like papilledema
• Important to distinguish—papilledema needs workup
• Avoids unnecessary testing

Diagnosis

• Clinical appearance (lumpy, elevated disc, no hyperemia)
• OCT—shows drusen, no subretinal fluid
• B-scan ultrasound—drusen are bright
• Autofluorescence—drusen glow
• CT orbit (rarely needed)—shows calcification

Key Differences from Papilledema

Feature	Drusen	Papilledema
Disc margins	Irregular, lumpy	Blurred, hyperemic
Vessels	Normal	Dilated, obscured
Hemorrhages	Rare	Common
Symptoms	Usually none	Headache, TVOs

Management

• Confirmation of diagnosis
• Baseline visual field testing
• Periodic monitoring (every 1-2 years)
• No treatment to remove drusen
• Manage any visual field loss conservatively

Prognosis

Excellent for most. Progressive visual field loss occurs in minority. Central vision usually preserved.